The Addition of Aromatase Inhibitors to Gonadotropin Releasing Hormone Analogues, Does It Improve Height Prediction in Girls with Low Estimated Adult Height? A Retrospective Study

Abstract

Background and Objectives: The aim of this study is to investigate if the addition of Aromatase Inhibitors to Gonadotropin releasing analogue can increase the predicted adult height in girls with low predicted adult height. Materials and Methods: This is a retrospective cohort study conducted in pediatric endocrine clinics in Dr Jamal Ahmad Rashed Hospital and Mercy Hospital between November 2024 and August 2025. Gonadotropins releasing analogue therapy for at least 1 year due to central precocious puberty, or low predicted adult height, were included in the study. After excluding group 3 because of small sample size, there were 3 groups: (1) Gonadotropin releasing analogue alone, (2) Gonadotropin releasing analogue + growth hormone, (4) Gonadotropin releasing analogue + growth hormone+ Aromatase Inhibitors.  The main outcomes were gain in estimated adult height and change in bone age /chronological age ratio Z-score. Results: Both Gonadotropin releasing analogue + growth hormone + Aromatase Inhibitors, and Gonadotropin releasing analogue + growth hormone showed higher Gain in estimated adult height than Gonadotropin releasing analogue alone, but the addition of Aromatase Inhibitors to Gonadotropin releasing analogue + growth hormone showed a mild advantage in Gain in Estimate adult height that was not statistically significant.  Bone age advancement was significantly less in the group with Aromatase Inhibitors. Conclusion: The addition of Aromatase Inhibitors to Gonadotropin releasing analogue and growth hormone is a feasible choice for selected girls in puberty with very low estimated adult height.