The field of therapy for central precocious puberty has been revolutionised by the development of superactive GnRH agonists. Episodic secretion of hypothalamic GnRH elicits pulsatile pituitary gonadotrophin release, but continuous infusion of GnRH downregulates GnRH receptors. The long-acting superagonists of GnRH have increased avidity for the GnRH receptors and are resistant to enzymatic degradation. These agents initially stimulate pituitary gonadotrophin secretion, but within days cause downregulation of the GnRH receptor, just as continuous GnRH infusion does, and gonadotrophin and gonadal steroid release decrease to the prepubertal level.
