Korean J Pediatr.  2007 Feb;50(2):198-204. 10.3345/kjp.2007.50.2.198.

Growth promoting effect of short-term gonadotropin releasing hormone agonist with or without growth hormone in girls with early puberty

• Lee EJ
• Han HS

• KMID: 2278728
• DOI: http://doi.org/10.3345/kjp.2007.50.2.198

Abstract

PURPOSE: The hope that arresting pubertal developement might increase final adult height has led to an attempt to use GnRH agonist (GnRHa) in children with early puberty and poor growth prognosis. We investigated the growth-promoting effect of GnRH agonists with or without growth hormone (GH) in girls with early puberty and decreased predicted adult height (PAH).
METHODS
Thirty five girls with advanced bone age and early pubertal signs were randomized for treatment for about 1 year with monthly GnRHa in group 1 (n=18), or with a combination of GH and GnRHa in group 2 (n=17). The following growth parameters were compared between groups, and the difference (delta) before and after treatment:chronological age (CA), bone age (BA), delta(BA-CA), height (HT), target height (TH), predicted adult height (PAH), delta (TH-PAH), serum insulin-like growth factor (IGF-1) and insulin-like growth factor binding protein (IGFBP-3).
RESULTS
Before treatment, BA, TH, PAH Standard deviation scores (SDS), delta(TH-PAH) were not different between the two groups, but CA was higher in group 2 and delta(BA-CA) were higher in group 1 (P<0.05). After 1.06+/-0.93 year of treatment, delta (BA-CA) decreased and there were significant changes in PAH and delta (TH-PAH), especially in group 2 (P<0.05 in group 1, and P<0.001 in group 2). In both groups, IGF-1 and IGFBP-3 were not different before and after treatment, but after treatment, IGF-1 level in group 2 was marginally higher than IGF-1 in group 1 (P<0.1).
CONCLUSION
Compromised predicted adult height in girls with early puberty and advanced bone age was significantly improved with GnRH with/without GH treatment in the short-term period. The addition of GH to GnRHa results in a significant increase in PAH compared to GnRHa alone because GnRHa suppressed growth hormone-IGF-1 axis. For comparison of final adult height, further longitudinal follow-up will be needed.

Keyword

Growth hormone; Gonadotropin releasing hormone agonist; Puberty; Bone age; Predicted adult height

MeSH Terms

Adolescent
Adult
Axis, Cervical Vertebra
Carrier Proteins
Child
Female*
Follow-Up Studies
Gonadotropin-Releasing Hormone*
Gonadotropins*
Growth Hormone*
Hope
Humans
Insulin-Like Growth Factor Binding Protein 3
Insulin-Like Growth Factor I
Prognosis
Puberty*
Carrier Proteins
Gonadotropin-Releasing Hormone
Gonadotropins
Growth Hormone
Insulin-Like Growth Factor Binding Protein 3
Insulin-Like Growth Factor I