Published online March 30, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. e752-e762 (doi:10.1542/peds.2008-1783)
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SPECIAL ARTICLE

Consensus Statement on the Use of Gonadotropin-Releasing Hormone Analogs in Children

Jean-Claude Carel, MD, PhDa, Erica A. Eugster, MDb, Alan Rogol, MD, PhDb,c, Lucia Ghizzoni, MDd, Mark R. Palmert, MD, PhDe,f on behalf of the members of the ESPE-LWPES GnRH Analogs Consensus Conference Group

a Department of Pediatric Endocrinology and Diabetes, INSERM U690, and Centre de Référence des Maladies Endocriniennes de la Croissance, Robert Debré Hospital and University Paris 7 Denis Diderot, Paris, France
b Section of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
c Division of Endocrinology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
d Centro per gli Stati Disendocrini e Dismetabolici, Dipartimento dell'Età Evolutiva, Università Degli Studi di Parma, Parma, Italy
e Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
f Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada

OBJECTIVE. Gonadotropin-releasing hormone analogs revolutionized the treatment of central precocious puberty. However, questions remain regarding their optimal use in central precocious puberty and other conditions. The Lawson Wilkins Pediatric Endocrine Society and the European Society for Pediatric Endocrinology convened a consensus conference to review the clinical use of gonadotropin-releasing hormone analogs in children and adolescents.

PARTICIPANTS. When selecting the 30 participants, consideration was given to equal representation from North America (United States and Canada) and Europe, an equal male/female ratio, and a balanced spectrum of professional seniority and expertise.

EVIDENCE. Preference was given to articles written in English with long-term outcome data. The US Public Health grading system was used to grade evidence and rate the strength of conclusions. When evidence was insufficient, conclusions were based on expert opinion.

CONSENSUS PROCESS. Participants were put into working groups with assigned topics and specific questions. Written materials were prepared and distributed before the conference, revised on the basis of input during the meeting, and presented to the full assembly for final review. If consensus could not be reached, conclusions were based on majority vote. All participants approved the final statement.

CONCLUSIONS. The efficacy of gonadotropin-releasing hormone analogs in increasing adult height is undisputed only in early-onset (girls <6 years old) central precocious puberty. Other key areas, such as the psychosocial effects of central precocious puberty and their alteration by gonadotropin-releasing hormone analogs, need additional study. Few controlled prospective studies have been performed with gonadotropin-releasing hormone analogs in children, and many conclusions rely in part on collective expert opinion. The conference did not endorse commonly voiced concerns regarding the use of gonadotropin-releasing hormone analogs, such as promotion of weight gain or long-term diminution of bone mineral density. Use of gonadotropin-releasing hormone analogs for conditions other than central precocious puberty requires additional investigation and cannot be suggested routinely.

Key Words: precocious puberty • GnRH analogs • development

Abbreviations: GnRHa—gonadotropin-releasing hormone analog • CPP—central precocious puberty • ESPE—European Society for Pediatric Endocrinology • LWPES—Lawson Wilkins Pediatric Endocrine Society • AH—adult height • BA—bone age • CA—chronological age • LH—luteinizing hormone • FSH—follicle-stimulating hormone • SDS—SD score • GH—growth hormone • BMD—bone mineral density • PCOS—polycystic ovarian syndrome • ISS—idiopathic short stature • SGA—small for gestational age • CAH—congenital adrenal hyperplasia

Accepted Dec 2, 2008.


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