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

OBJECTIVE. Gonadotropin-releasing hormone analogs revolutionized the treatment ofcentral precocious puberty. However, questions remain regarding their optimal usein central precocious puberty and other conditions. The Lawson Wilkins PediatricEndocrine Society and the European Society for Pediatric Endocrinology convened aconsensus conference to review the clinical use of gonadotropin-releasing hormoneanalogs in children and adolescents.PARTICIPANTS. When selecting the 30 participants, consideration was given to equalrepresentation from North America (United States and Canada) and Europe, anequal male/female ratio, and a balanced spectrum of professional seniority andexpertise.EVIDENCE. Preference was given to articles written in English with long-term outcomedata. The US Public Health grading system was used to grade evidence and rate thestrength of conclusions. When evidence was insufficient, conclusions were based onexpert opinion.CONSENSUS PROCESS. Participants were put into working groups with assigned topics andspecific questions. Written materials were prepared and distributed before the conference,revised on the basis of input during the meeting, and presented to the fullassembly for final review. If consensus could not be reached, conclusions were basedon majority vote. All participants approved the final statement.CONCLUSIONS. The efficacy of gonadotropin-releasing hormone analogs in increasingadult height is undisputed only in early-onset (girls 6 years old) central precociouspuberty. Other key areas, such as the psychosocial effects of central precociouspuberty and their alteration by gonadotropin-releasing hormone analogs, need additionalstudy. Few controlled prospective studies have been performed with gonadotropin-releasing hormone analogs in children, and many conclusions rely in parton collective expert opinion. The conference did not endorse commonly voicedconcerns regarding the use of gonadotropin-releasing hormone analogs, such aspromotion of weight gain or long-term diminution of bone mineral density. Use ofgonadotropin-releasing hormone analogs for conditions other than central precociouspuberty requires additional investigation and cannot be suggested routinely.