The effect of pubertal delay by GnRH agonist in GH-deficient children on final height.

Several strategies can be applied to optimize GH treatment in GH-deficient (GHD) children during puberty (1). In a recent issue of JCEM, Mericq et al. (2) reported their results of a prospective, randomized trial on the effect of GH alone or in combination with GnRH agonist (GnRHa) in pubertal GHD patients. They concluded that delaying puberty by GnRHa led to a near final height (FH) sd score of 1.3 0.5 compared with 2.7 0.3 in the group treated with GH alone. However, in this study, the patients had been untreated up to the age of 12–18.5 yr, which is unusual for western countries. In addition, in several cases the growth retardation was less severe than would be expected in classical GHD patients without treatment. Although a randomized controlled trial in a large and representative sample is certainly the best design to study the efficacy of a therapeutical regimen, a patient series with matched controls is a good second. We report on a retrospective analysis of the effect of the addition of GnRHa (shortly after the onset of puberty) to GH treatment in GHD children. Matched controls with GH treatment were used for comparison. The children were younger as well as shorter for age compared with the subjects in the randomized trial (2).