Is there a place for combined therapy with GnRH agonist plus growth hormone in improving final height in short statured children?

The availability of recombinant human growth hormone (GH) and the optimizat ion of substitutive therapy have improved final growth in children with GH deficiency, but despite this some of them fail to grow to their genetic pot ential. In particular, this may occur in patients who started the substitut ive therapy too late and/or in whom bone age progressed too fast during GH administration. In these patients, with unfavorable auxological characteris tics, the administration of a GnRH agonist in combination with GH may slow down bone maturation and prolong prepubertal growth, mimicking, to some ext ent, the growth pattern of patients with On + Gn deficiency who grow better than children with isolated GHD, A different condition in which such a com bined therapy might be used is the short normal child. As they are short bu t normally-growing children, the onset of puberty is in general appropriate for their chronological age but precocious for their height age, Thus, slo wing down pubertal maturation may increase the time available for growth. G H would sustain growth during both GnRHa administration and after its withd rawal, when puberty starts again. Our preliminary results suggest that the administration of GH + GnRHa in combination may have a positive effect on f inal height in selected children with isolated GHD and in short normal chil dren.