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PEDIATRICS Vol. 104 No. 4 Supplement October 1999, pp. 1014-1018

Combined Use of Growth Hormone and Gonadotropin-releasing Hormone Analogues: The National Cooperative Growth Study Experience

Received May 13, 1999; accepted Jun 22, 1999 .

Brenda Kohn*, Joanne R. JuliusDagger , and Sandra L. BlethenDagger

From the * Division of Pediatric Endocrinology, Long Island College Hospital, Brooklyn, New York; and the Dagger  Department of Medical Affairs, Genentech, Inc, South San Francisco, California.

Gonadotropin-releasing hormone ana-logues (GnRHa) are used to treat central precocious puberty. They also are used to delay puberty in short children with a prognosis for impaired adult height. In both cases, growth hormone (GH) treatment is sometimes added. To determine how North American pediatric endocrinologists are using the combination of GH and GnRHa, we searched the National Cooperative Growth Study (NCGS) database and identified 509 patients who were treated with both. Among them were 139 patients with a diagnosis of precocious puberty. Most of these (82%) also had GH deficiency (GHD). Of the 370 patients who did not have precocious puberty, 71% had GHD. There were 200 patients with precocious puberty who were treated with GH but not with GnRHa. The children who were given GH alone (77% of whom had GHD) were much younger than the children who were given both GH and GnRHa (5.7 ± 2.9 years for those who were not treated with GnRHa vs 9.1 ± 2.7 years for those who were).

Data on both predicted adult height before GH treatment and near- adult height were available for 141 of the patients who were given both GH and GnRHa. There was a statistically significant increase in near-adult height over pre-GH predicted adult height in girls with precocious puberty (5.4 ± 4.3 cm) and without precocious puberty (3.0 ± 6.1 cm). There was no statistically significant gain in height for boys who did not have precocious puberty (1.3 ± 6.8 cm). There were too few boys with precocious puberty (n = 7) to enable meaningful conclusions. In a multiple regression analysis of data on girls who did not have precocious puberty, duration of GH treatment was the most important variable predictive of height gain.gonadotropin-releasing hormone, growth hormone, precocious puberty, idiopathic growth hormone deficiency, organic growth deficiency, idiopathic short stature.

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