Carel Jean Claude
Department of Pediatric Endocrinology, Hôpital Robert Debré and Faculté de Médecine Réné Descartes PARIS 5, Paris, France.
Mol Cell Endocrinol. 2006 Jul 25;254-255:226-33. doi: 10.1016/j.mce.2006.04.034. Epub 2006 Jun 19.
Adolescent growth is the focus of several interventions aimed at increasing the amplitude of the adolescent spurt. Favorable results with GnRH agonists in precocious puberty have encouraged attempts to increase the duration of the adolescent growth spurt by delaying normal puberty in short individuals using GnRH agonists with or without growth hormone. These approaches remain highly controversial, have not been validated and approved for use by regulatory authorities and were the topic of a session at the 6th International Conference on the Onset of Puberty. Here we review the available information on the efficacy and safety of this approach. GnRH agonists, when used outside the context of precocious puberty, induce a modest gain when used for extended periods of time. Several trials have now shown that growth hormone alone can modestly increase adult height in short adolescents with idiopathic short stature or in those born small for gestational age. The association of growth hormone and GnRH agonists still lacks a definite demonstration of its additional efficacy and available results do not allow firm conclusions. In conclusion, watchful waiting or sex steroids in delayed puberty are generally the best options in short children presenting around puberty. However, long-term and adequately powered clinical trials, focusing on efficacy, safety and clinical significance are needed to fully evaluate the combination of growth hormone and GnRH agonists in short adolescents. In the meanwhile, these approaches should be considered as experimental.
青少年生长是旨在增加青春期生长突增幅度的几种干预措施的重点。促性腺激素释放激素（GnRH）激动剂在性早熟治疗中取得的良好效果，促使人们尝试通过使用GnRH激动剂（无论是否联合生长激素）来延迟身材矮小个体的正常青春期，从而延长青春期生长突增的持续时间。这些方法仍存在很大争议，尚未得到监管机构的验证和批准，并且是第六届青春期启动国际会议上一场会议的主题。在此，我们回顾一下关于这种方法的有效性和安全性的现有信息。GnRH激动剂在性早熟之外的情况下使用时，长期使用会带来适度的身高增长。现在多项试验表明，生长激素单独使用可适度增加特发性身材矮小的青少年或小于胎龄儿成年后的身高。生长激素与GnRH激动剂联合使用的额外疗效仍缺乏明确的证据，现有结果也无法得出确凿结论。总之，对于青春期前后出现身材矮小的儿童，密切观察或使用性类固醇通常是最佳选择。然而，需要开展长期且有足够样本量的临床试验，重点关注有效性、安全性和临床意义，以全面评估生长激素与GnRH激动剂联合使用对身材矮小青少年的影响。与此同时，这些方法应被视为试验性的。
