From the Guidelines
Treatment with a puberty-delaying medication, such as a GnRH agonist, is justified in this case to slow down rapid puberty progression and allow for continued growth with Somapacitan treatment. The patient's rapid progression of puberty, as evidenced by advanced bone age and testicular volume, poses a risk of premature epiphyseal fusion, which could limit their potential height gain. According to the most recent and highest quality study, 1, GnRH analogues can be used to temporarily suppress puberty, allowing for continued growth and development. The benefits of this approach include maximizing height potential, delaying menarche, and optimizing development of secondary sex characteristics, as noted in 1. Key considerations for treatment include:
- Regular monitoring of bone age, growth velocity, pubertal development, and hormone levels every 3-6 months to assess treatment efficacy
- Selection of an appropriate GnRH agonist, such as leuprolide acetate or histrelin implant, and dosing regimen
- Continuation of treatment until optimal height gains are achieved or bone age approaches 14 years in boys
- Potential adverse effects, including reduced height velocity and potentially reduced peak bone mass accrual, as noted in 1. Overall, the use of a GnRH agonist in this case can help to balance the need for continued growth and development with the risk of premature epiphyseal fusion, ultimately improving the patient's quality of life and outcomes.
From the Research
Justification for Diphrelene (GnRH Agonist) Treatment
The patient in question has a known case of short stature due to growth hormone deficiency and has been improving on Somapacitan treatment. However, the patient is experiencing rapid progression of puberty, which may lead to early closure of the epiphyseal growth plates and limit the potential for further growth.
- The patient's current height is 151.5 cm, which is on the 5th percentile, and the mid-parental height (MPH) is 174 cm.
- The bone age is estimated to be around 13 years, which is advanced for the patient's chronological age.
- The patient's growth velocity is 2 cm over the last 3 months, which is relatively slow.
Rationale for GnRH Agonist Treatment
GnRH agonist treatment, such as diphrelene, may be justified in this case to slow down the rapid progression of puberty and allow for continued growth with Somapacitan treatment. This is supported by studies that have shown the effectiveness of GnRH agonists in improving adult height in patients with central precocious puberty (CPP) or early puberty 2, 3, 4.
- A study published in 2006 found that GnRH agonist therapy can increase adult height in patients with CPP or early puberty, especially when combined with growth hormone treatment 2.
- Another study published in 2018 found that combination therapy with GnRH agonists and recombinant human growth hormone (rhGH) may be beneficial in preserving or reclaiming growth potential and improving adult height in girls with ICPP or early puberty 3.
- However, a study published in 2009 found that GnRH agonist treatment may induce an inappropriate growth deceleration in some patients, impairing height outcome 5.
Potential Benefits and Risks
The potential benefits of GnRH agonist treatment in this case include:
- Slowing down the rapid progression of puberty and allowing for continued growth with Somapacitan treatment.
- Improving adult height and reducing the risk of short stature.
However, there are also potential risks and side effects to consider, including:
- Menopausal-like complaints and changes in body composition.
- Potential effects on brain function and mental health, as seen in animal studies 6.
Overall, the decision to use GnRH agonist treatment in this case should be based on a careful consideration of the potential benefits and risks, as well as the individual patient's needs and circumstances.