A brief review of the addition of gonadotropin-releasing hormone agonists (GnRH-Ag) to growth hormone (GH) treatment of children with idiopathic growth hormone deficiency: Previously published studies from America

Despite aggressive, early and continuous growth hormone (GH) treatment of children with idiopathic (I) growth hormone deficiency (GHD), height outcomes are often below −1 SDS and do not achieve mid-parental height targets. As pubertal growth accounts for 15% of total growth and gonadotropin-releasing hormone agonist (GnRH-Ag) therapy has successfully prolonged the “prepubertal” growth phase in central precocious puberty, the addition of GnRH-Ag to GH in IGHD has been widely utilized to try to enhance linear growth. Results in the two large GH registry databases and GH prediction models do not support the success of such treatment, although several smaller, controlled trials do indicate some value. Whether GnRH-Ag therapy could be more successful if its use were related to the tempo or age of onset of puberty in a specific child is not known. No universally agreed guidelines exist for the use of GnRH-Ag plus GH in children with GHD or other short stature syndromes and may still be considered experimental.