Dear Cathy,

I was alarmed to read your recent note on page 2, stating that your daughter's BA has advanced more than 2 years in the last 8 months, since being put on Synarel spray for CPP.  I don't know if you got the information from your doctor that Synarel is not supposed to slow bone age, but that is just NOT TRUE---otherwise what is the point of taking it?  (Please see the excerpt below, from http://www.healthandage.com/html/res/pdr/html/76007000.htm ).  This is just one of a number of different websites about Synarel on the net.  I'm sure you can find many more, by utilizing a general search engine, such as google.com, and they will all say the same thing. 

I fear that the problem here is possibly one of compliance---not hard to believe since, from what I read, the Synarel spray has to be administered 8X/day(!), in order for it to be effective (2X in each nostril, twice a day).  I hope you don't take this the wrong way---I am not trying to insinuate you did anything wrong---believe me, if I had to give my son 8 sprays in his nostrils every day, I'm sure we would quickly have a problem with non-compliance, as well (or, at least, spotty compliance, given the fact that I find nose sprays extremely difficult to properly administer, in the first place.)

The problem is (and this is something your doctor really should have stressed to you), with a drug like Synarel or Lupron, giving too little of the medication is almost worse than giving none, at all.  It is because both of these drugs actually work by stimulating the pituitary gland, before it quiets it down.  If your daughter is not getting as much from the medication as she should be, every single day---and especially, if she is getting a little bit less---the Synarel could actually be making her situation worse than it otherwise would be.   It's probably a good idea to talk further with your doctor about this, as soon as you can.

"When used regularly in girls and boys with central precocious puberty (CPP) at the recommended dose, SYNAREL suppresses LH and sex steroid hormone levels to prepubertal levels, affects a corresponding arrest of secondary sexual development, and slows linear growth and skeletal maturation......Linear growth velocity, which is commonly pubertal in children with CPP, is reduced in most children within the first year of treatment....... height for chronological age approaches normal in most children during the second or third year of treatment with SYNAREL.....in most children, bone age velocity approaches normal (1) during the first year of treatment......"