peer reviewed ; Objectives: Information on the efficacy of GH treatment in short SGA children starting their treatment in adolescence is limited. Therefore, adult height (AH), total height gain, and pubertal height gain were evaluated in short SGA children who started GH treatment at pubertal onset. Patient and Methods: Growth data of 47 short SGA adolescents (22 boys) who started GH treatment at pubertal onset (PUB group) were compared with results from 27 short SGA patients (11 boys) who started GH therapy at least 1 year before pubertal onset (PrePUB group). Results: The PUB group achieved a mean (+/-SD) total height gain of 0.8 +/- 0.7 SDS and an AH of -2.5 +/- 0.7 SDS after 4.1 +/- 1.1 years of GH treatment with a dosage of 41.8 +/- 8.4 mug/kg/day. These results were comparable with those in the PrePUB group, which was treated for a longer duration (5.8 +/- 2.1 years), resulting in a total height gain of 1.1 +/- 0.7 SDS and an AH of -2.1 +/- 1.0 SDS. Multiple regression analysis showed a significantly lower height gain in pubertal patients, females, and patients weighing less at start of GH treatment. An AH above -2 SDS and above the parent-specific lower limit of height was, respectively, reached in 28% and 70% of PUB and 44% and 67% of PrePUB patients (NS). AH SDS was positively correlated with the height SDS at start of GH. Conclusions: Short SGA adolescents starting GH therapy at an early pubertal stage have a modest and variable height gain. A normal AH can be expected in one third of the patients, especially in those with a smaller height deficit at onset of GH treatment.