Consensus statement on the use of gonadotropin-releasing hormone analogs in children.
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.


METHODS
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.


METHODS
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.


METHODS
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.
Carel
Jean-Claude
JC
Department of Pediatric Endocrinology and Diabetes, INSERM U690, Robert Debré Hospital and University Paris, France. jean-claude.carel@inserm.fr
Eugster
Erica A
EA
Rogol
Alan
A
Ghizzoni
Lucia
L
Palmert
Mark R
MR
Antoniazzi
Franco
F
Berenbaum
Sheri
S
Bourguignon
Jean-Pierre
JP
Chrousos
George P
GP
Coste
Joël
J
Deal
Sheri
S
de Vries
Liat
L
Foster
Carol
C
Heger
Sabine
S
Holland
Jack
J
Jahnukainen
Kirsi
K
Juul
Anders
A
Kaplowitz
Paul
P
Lahlou
Najiba
N
Lee
Mary M
MM
Lee
Peter
P
Merke
Deborah P
DP
Neely
E Kirk
EK
Oostdijk
Wilma
W
Phillip
Moshe
M
Rosenfield
Robert L
RL
Shulman
Dorothy
D
Styne
Dennis
D
Tauber
Maïthé
M
Wit
Jan M
JM