An 11-year-old girl complaining of an eating disorder treated with triptorelin (3.75 mg every 28 days) for which she had been taking HR-releasing hormone analogue gonadotropin (Gn).
The hormonal braking treatment was suspended and she was referred to the Psychiatric Service.
The process begins when parents consult in a private hospital due to the fact that the appearance of menarche limited the growth of the child.
They were informed that treatment with GnRH analogue could result in an improvement in final height of up to 5 cm, with no side effects observed during the first year of treatment.
The family accepted the proposed treatment.
The pediatrician's medical report that prescribed the GnRH analogue when the child was 11.15 years old chronologically refers to the most relevant data as shown in Table 1.
The medical report includes precocious puberty (PP) diagnosis.
1.
During the course of treatment with GnRH analogue, the girl experienced a weight gain, reaching 48.5 kg at three months and subsequently began a voluntary limitation of intakes and increased physical exercise (38.8 kg to lose almost 10 kg).
The belief that a girl will not grow after menarche is a widespread and mistaken idea, assuming that a later menarche will significantly improve final height.
We should not forget that the main determinant of adult height is genetics and not the starting point for pubic growth1.
When menarche is manifested naturally, an increase in final height of 0.35 cm per year of delay in the onset of symptoms of lower limb growth has been observed.
A descriptive clinical study conducted in Spain on physiological variations of development after pub30.3 showed that in girls with menarche before the age of 15.8 years, with a mean height of 15 ± 7.7 cm and a final menarche of 15 ± 6.0 cm.
The use of GnRH analogues is accepted in Pediatrics exclusively for the treatment of PP.
The Summary of Product Characteristics (SPC) of the Spanish Agency for Medicines and Health Products (AEMPS) concerning triptorelin4 limits employment to girls under eight years of age.
From this age on, it can only be prescribed as off-label drugs.
There are no clinical studies that justify the use of GnRH analogues in healthy normal-sized girls in order to improve final height.
Clinical studies in girls with idiopathic precocious puberty (IPP) only show improvement in final height in girls when treatment is started in children under 6 years old.
In cases of treatment in girls with short stature without PP with GnRH analogues it is observed that the benefit risk is not justified in girls with puberty in normal range.
In Spain, treatment studies have been conducted with GnRH analogues in girls of low family size7, concluding that the combined treatment of growth hormone and GnRH causes that the final gain in height ratio was not similar in the control group.
Gain as a consequence of treatment with GnRH analogues is recorded in the AEMPS technical file as a common adverse reaction in women and present in children.
It has been observed that this treatment does not slow the development of adipocyte and thus in children with PPI treatment with GnRH analogues was accompanied by an increase in body mass index treatment8.
In today's society, high height and weight in thin range in girls and adolescents are promoted as desirable values in themselves, even in girls with strictly normal auxological values, where there is no obvious benefit to medical literature, compromising the development.
Primary care pediatricians should ensure the health of our population and avoid, as far as possible, therapies that are not rigorous and do not respond to deleterious effects.
At the same time, more demanding legislation is needed to protect children and their families in relation to off-label drugs.
