What is the role of gonadotropin-releasing hormone (GnRH) agonists in the treatment of hyposomatotropism (growth hormone deficiency [GHD])?

Updated: Jan 24, 2019
  • Author: Sunil Kumar Sinha, MD; Chief Editor: Robert P Hoffman, MD  more...
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Answer

Gonadal steroids are important mediators of bone development. When normal or precocious puberty limits the response to GH, delaying puberty with an analog of luteinizing hormone-releasing hormone may be appropriate. However, this strategy in pubertal patients has not led to documented enhancements in final heights.

Nevertheless, the younger the age of pubertal onset, the lower the patient's final height. As a result, leuprolide has been used in patients with fast-tempo puberty or in those in whom GHD was diagnosed late. In a recent multicenter trial in pubertal children (predominantly boys) with GHD, high-dose rhGH 0.7 mg/kg/wk increased near-final heights, without a change in the safety profile. Both of these therapeutic strategies require further study.

GHRH ghrelin is a synthetic form of an identified endogenous ligand for the GH-secretagogue receptor. Ghrelin is involved in a novel system for regulating GH release. It is an acylated peptide with a molecular weight of 3300 Da. Intravenously administered ghrelin stimulated GH release in primary pituitary cell cultures and serum GH in rats. Furthermore, ghrelin strongly stimulates GH release in humans. These characteristics make this peptide a possible therapeutic tool for the future.


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