EFFECT OF COMBINED TREATMENT WITH GONADOTROPIN-RELEASING-HORMONE ANALOG AND GROWTH-HORMONE IN PATIENTS WITH CENTRAL PRECOCIOUS PUBERTY WHO HAD SUBNORMAL GROWTH VELOCITY AND IMPAIRED HEIGHT PROGNOSIS

Growth hormone-insulin-like growth factor-I status and response to gro wth hormone therapy (0.6IU/kg/week sc, six times a week for 12 months) were evaluated in 12 girls (chronological age 9.4 +/- 1.6 years) suff ering from central precocious puberty with growth velocity less than 4 cm/year and no substantial increase or decrease in predicted adult he ight during gonadotropin releasing hormone (Gn-RH) analogue treatment( D-Trp(6)-LH-RH, 60 mu g/kg im/28 days). At baseline, large variations were observed in nocturnal growth hormone (GH) means (pathological val ues (< 3.6 mu g/l) 33.3%), stimulated levodopa GH peaks (pathological values (<10.0 mu g/l) 28.6%) and serum insulin-like growth factor-I (I GF-I) levels. Neither GH nor IGF-I levels were correlated with growth velocity. During recombinant GH therapy, growth velocity increased sig nificantly (baseline 3.0 +/- 0.9 cm/year; 6 months 6.4 +/- 1.9 cm/year , p < 0.001 versus baseline; 12 months 6.0 +/- 1.3 cm/year, p < 0.001 versus baseline). There was a significant increase in height SDS for b one age (baseline -1.6 +/- 0.5 SDS; 12 months -1.04 +/- 0.6 SDS; p < 0 .002) and in predicted adult height (baseline 152.0 +/- 3.6 cm; 12 mon ths 155.9 +/- 3.4 cm; p < 0.002). Our results suggest that combined th erapy with Gn-RH analogues and recombinant GH can improve growth veloc ity and predicted adult height in girls with central precocious pubert y and impaired height prognosis during Gn-RH analogue treatment.