COMBINED TREATMENT WITH GONADOTROPIN-RELEASING-HORMONE ANALOG AND GROWTH-HORMONE IN CENTRAL PRECOCIOUS PUBERTY

GnRH analogs (GnRHa) arrest pubertal development and slow growth veloc ity (GV) and bone maturation, thus improving adult height in central p recocious puberty (CPP). In some patients, however, GV decreases to su ch an extent that it compromises the improvement in predicted adult he ight (PAH). Fourteen children (10 girls and 4 boys) with idiopathic CP P whose GV during GnRHa treatment decreased below the 25th percentile for chronological age with no improvement in PAH received GH at a dose of 0.3 mg/kg . week, sc, 6 days/week for 2-3 yr. Fourteen children (1 0 girls and 4 boys) with idiopathic CPP, matched for bone age IBA), ch ronological age, and duration of GnRHa treatment, who showed the same growth deceleration but refused GH treatment, served as the control gr oup. In girls, GV as so score for BA improved from -3.4 +/- 0.5 to -2. 5 +/- 0.5 after 3 yr of combined treatment; PAH significantly improved from 152.7 +/- 1.7 cm (before GnRHa) and 153.5 +/- 1.7 cm (before GnR Ha and GH) to 167.1 +/- 3.0 cm after 3 yr of combined treatment (P < 0 .01 us. pretreatment with GnRHa plus GH). In boys, GV as SD score for BA remained unchanged from -2.0 +/- 1.0 to -2.2 +/- 1.2 after 2 yr of combined treatment; PAH increased from 166.6 +/- 4.8 cm (before GnRHa) and 166.2 +/- 4.9 (before GnRHa plus GH) to 171.1 +/- 6.1 cm after 2 yr (P = NS). In the control group, in girls after 6 yr of GnRHa treatm ent, height in so score for BA improved from -1.0 +/- 0.3 to -0.1 +/- 0.4 (P = NS), and PAH significantly improved from 155.5 +/- 2.0 to 161 .5 +/- 2.1 cm (P < 0.05); in boys after 4 yr of GnRHa treatment, heigh t in so score for BA improved from -1.1 +/- 0.3 to -0.3 +/- 0.4 (P = N S), and PAH changed from 172.6 +/- 3.6 to 170.3 +/- 3.6 cm (P = NS). E ight of 10 girls receiving GH plus GnRHa treatment had an actual heigh t higher than PAH and their target height. The results of our long ter m study indicate that in children with CPP who show a marked decrease in GV during GnRHa treatment, GH administration remarkably improves gr owth velocity and predicted adult height, especially in girls.