This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Saggese, G. Articles by Fiore, L. Search for Related Content PubMed PubMed Citation Articles by Saggese, G. Articles by Fiore, L.

The Effect of Administering Gonadotropin-Releasing Hormone Agonist with Recombinant-Human Growth Hormone (GH) on the Final Height of Girls with Isolated GH Deficiency: Results from a Controlled Study

Endocrine Unit, Division of Pediatrics, Department of Reproductive Medicine and Pediatrics, University of Pisa, Santa Chiara Hospital, I-56125 Pisa, Italy

Address correspondence and requests for reprints to: Giovanni Federico, M.D., Clinica Pediatrica, Università di Pisa, Ospedale S. Chiara, Via Roma 67, I-56125 Pisa, Italy.

To assess whether delaying puberty may improve final height in GH-deficient children with a poor height prediction at early puberty, we studied 24 girls with isolated GH deficiency until they reached their final height, in a controlled trial. Patients were taking recombinant human GH (r-hGH) substitutive therapy from 2.1 ± 0.5 yr (0.1 IU/kg·day sc) before entering the study, without showing any improvement in height prediction (149.6 ± 2.9 vs.150.3 ± 2.2 cm) on entering puberty. Fourteen girls agreed to add a GnRH agonist (GnRHa) to r-hGH, whereas the remaining 10 decided against it and served as controls. At the start of the study, girls treated with or without GnRHa had similar auxological characteristics (bone age, 10.9 ± 0.6 vs. 10.7 ± 1.3 yr; height SD score for chronological age, -1.87 ± 0.3 vs. -1.82 ± 0.2), including pubertal development. The GnRHa (long-acting D-Trp-6-GnRH) was given at 60 µg/kg im every 28 days for 1.9 ± 0.9 yr, then patients continued the r-hGH at the same dosage (3.1 ± 0.7 yr). At the end of the study, bone age was 16.2 ± 0.3 yr in GnRHa-treated girls and 16.6 ± 0.9 yr in controls. Bone maturation was significantly slower during GnRHa (1.4 ± 0.2 yr), and height SD score for bone age improved (-0.31 ± 0.3) in comparison with controls (2.6 ± 0.4 yr and -1.35 ± 0.3 SD score; P < 0.001 and P < 0.0001, respectively). As a result, girls given the combined therapy reached a final height higher than that of controls (height SD score, -0.39 ± 0.5 vs. -1.45 ± 0.2; P < 0.0001) and also higher than their midparental height (-1.1 ± 0.5; P < 0.0005). Controls reached their midparental height. In conclusion, our results demonstrate that slowing pubertal development with the administration of GnRHa for a limited time may improve final height in GH-deficient girls selected because of a poor height prediction at early puberty.

This article has been cited by other articles:

				J.-C. Carel, E. A. Eugster, A. Rogol, L. Ghizzoni, M. R. Palmert, and on behalf of the members of the ESPE-LWPES GnRH An Consensus Statement on the Use of Gonadotropin-Releasing Hormone Analogs in Children Pediatrics, April 1, 2009; 123(4): e752 - e762. [Abstract] [Full Text] [PDF]

				M. J. E. Walenkamp, A. M. Pereira, W. Oostdijk, W. H. Stokvis-Brantsma, R. W. Pfaeffle, O. Blankenstein, and J. M. Wit Height Gain with Combined Growth Hormone and Gonadotropin-Releasing Hormone Analog Therapy in Two Pubertal Siblings with a Growth Hormone-Releasing Hormone Receptor Mutation J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 204 - 207. [Abstract] [Full Text] [PDF]

				H K Gleeson and S M Shalet The impact of cancer therapy on the endocrine system in survivors of childhood brain tumours Endocr. Relat. Cancer, December 1, 2004; 11(4): 589 - 602. [Abstract] [Full Text] [PDF]

				S. E. Lerner, G. J. M. Huang, D. McMahon, C. A. Sklar, and S. E. Oberfield Growth Hormone Therapy in Children after Cranial/Craniospinal Radiation Therapy: Sexually Dimorphic Outcomes J. Clin. Endocrinol. Metab., December 1, 2004; 89(12): 6100 - 6104. [Abstract] [Full Text] [PDF]

				C. M. Brownstein, A. C. Mertens, P. A. Mitby, M. Stovall, J. Qin, G. Heller, L. L. Robison, and C. A. Sklar Factors That Affect Final Height and Change in Height Standard Deviation Scores in Survivors of Childhood Cancer Treated with Growth Hormone: A Report from the Childhood Cancer Survivor Study J. Clin. Endocrinol. Metab., September 1, 2004; 89(9): 4422 - 4427. [Abstract] [Full Text] [PDF]

				M. B. Ranke, A. Lindberg, D. D. Martin, B. Bakker, P. Wilton, K. Albertsson-Wikland, C. T. Cowell, D. A. Price, and E. O. Reiter The Mathematical Model for Total Pubertal Growth in Idiopathic Growth Hormone (GH) Deficiency Suggests a Moderate Role of GH Dose J. Clin. Endocrinol. Metab., October 1, 2003; 88(10): 4748 - 4753. [Abstract] [Full Text] [PDF]

				H. K. Gleeson, R. Stoeter, A. L. Ogilvy-Stuart, H. R. Gattamaneni, B. M. Brennan, and S. M. Shalet Improvements in Final Height Over 25 Years in Growth Hormone (GH)-Deficient Childhood Survivors of Brain Tumors Receiving GH Replacement J. Clin. Endocrinol. Metab., August 1, 2003; 88(8): 3682 - 3689. [Abstract] [Full Text] [PDF]

				M. Tauber, B. Berro, V. Delagnes, N. Lounis, B. Jouret, C. Pienkowski, I. Oliver, and P. Rochiccioli Can Some Growth Hormone (GH)-Deficient Children Benefit from Combined Therapy with Gonadotropin-Releasing Hormone Analogs and GH? Results of a Retrospective Study J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1179 - 1183. [Abstract] [Full Text] [PDF]