[The use of aromatase inhibitors in children]

Aromatase inhibitors are compounds that block aromatase which converts androgens to estrogens. These compounds have been investigated for many years in a variety of conditions in which estrogen blockade is desired. During the past decade, a third generation of aromatase inhibitors has been developed with a much more potent blockade of the enzyme and less side effects. These new aromatase inhibitors are well absorbed after oral administration and, because of a long half life, are given once daily, thereby increasing compliance. The use of aromatase inhibitors is approved for the treatment of estrogen responsive breast cancer. Estrogens play a major role in bone maturation and growth plate fusion in both sexes. Therefore, inhibition of estrogen production may increase final height in a number of conditions where the final height is compromised. Due to their ability to block estrogen production, a number of clinical studies have been conducted to investigate their efficiency in a range of situations where estrogen blockade is desired. These include: peripheral precocious puberty secondary to congenital adrenal hyperplasia, familial male-dominant precocious puberty, and McCune-Albright syndrome, short stature in boys secondary to growth hormone deficiency, familial/genetic short stature, constitutional growth delay or idiopathic short stature. The use of aromatase inhibitors has been investigated also in pubertal gynecomastia. It is important to emphasize that this treatment, although it seems to be safe and encouraging, is still investigational and is not yet approved for routine usage.