The case for GnRH agonists in GH-deficient patients

The use of gonadotropin releasing hormone (GnRH) agonists in growth hormone (GH)-deficient children remains controversial. Evidence suggests that GnRH agonists can improve adult height by delaying epiphyseal closure, thereby allowing more time for growth during puberty. However, long-term treatment (>3 years) with GnRH agonists is needed to achieve significant growth, likely related to growth rate deceleration with GnRH agonists. In addition, the height gained following GnRH agonist treatment may not be significantly greater than that achieved with GH treatment alone. The timely diagnosis of GH deficiency and the initiation of GH therapy prior to puberty may provide sufficient height gains such that GnRH agonist therapy may be unnecessary. A clinician must balance multiple issues when considering GnRH agonist therapy, including physical concerns, such as reduced bone mineralization, psychological concerns stemming from significantly delaying puberty, as well as cost:benefit analysis. This review debates the use of GnRH agonist therapy in GH-deficient children.