Possible Disadvantages of Gonadal Suppression Therapy

Abstract

Gonadal suppression therapy is now used experimentally to improve the final height of children who enter puberty at the normal age but with short stature. For this purpose a long-acting analog of LH-releasing hormone (LHRHa) is usually used. To improve the final height, gonadal suppression must be continued for at least several years, and artificial delayed puberty may cause psychosocial problems. The accumulation of bone mineral is reported to be most active during puberty and it is related to the increased secretion of sex steroids. Suppression of sex steroid secretion at the normal pubertal age may result in poor bone mineral accumulation at this critical period and may become a risk factor for osteoporosis later in life. Gonadotropins are knownto be secreted in a pulsatile fashion even at prepubertal age. LHRHa abolishes gonadotropin secretion completely and may deteriorate pubertal development after completion of the therapy. There are reports of IgE antibody production and anaphylaxis caused by LHRHa treatment. If an antibody that cross-reacts with native LHRH is generated, it can be a cause of hypogonadism. We should take into account these possible disadvantages when giving gonadal suppression therapy to patients with basically normal puberty.