Histrelin is a synthetic gonadotrophin-releasing
hormone (
GnRH) agonist which, when administered over a prolonged period, suppresses the release of gonadotrophins from the anterior pituitary. Data from clinical trials undertaken in small numbers of patients with idiopathic
central precocious puberty have demonstrated that
histrelin 8 to 10 micrograms/kg/day administered subcutaneously desensitises the anterior pituitary to gonadotrophin secretion within 3 months, ablating the pubertal gonadotrophin response to
GnRH stimulation and reducing circulating gonadal sex
steroid levels. When
histrelin is administered to treat
central precocious puberty, the rate of secondary sexual maturation is slowed and in some cases there is a reversal of maturation which occurs before initiation of treatment. Of equal importance,
histrelin therapy appears to have decelerating effects on skeletal maturation, allowing more statural growth; an increase in final adult height is predicted from available data, but will need to be confirmed in long term follow-up studies currently being undertaken. The most common adverse event reported during
histrelin therapy was a skin reaction at the site of
subcutaneous injection. Few patients have discontinued
therapy because of any adverse event. Although experience with
histrelin is limited, the absence of effective clinically available alternatives and the demonstrated efficacy of
histrelin justifies its place as a first-line
therapy for patients with
central precocious puberty.