Central precocious puberty: revisiting the diagnosis and therapeutic management

Brito, Vinícius Nahime; Spinola-Castro, Ângela Maria; Kochi, Cristiane; Kopacek, Cristiane; Silva, Paulo César Alves da; Guerra‐Júnior, Gil

doi:10.1590/2359-3997000000144

Cited by 86 publications

(98 citation statements)

References 60 publications

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“…With the exception of four patients presenting with menarche, all patients were followed for 3-6 months before the treatment decision. GnRHa treatment was given to patients with progressive CPP, determined according to the following criteria: a) Growth velocity above 6 cm/year; b) Advanced BA defined as BA ≥2 years compared with chronological age; c) Rapid progression in pubertal stages defined as progression of puberty from one stage to the next in less than six months; and d) Decrease in predicted adult height compared to target height (14). Pituitary MRI was performed in all cases and the underlying organic pathology was investigated.…”

Section: Methodsmentioning

confidence: 99%

Treatment with Depot Leuprolide Acetate in Girls with Idiopathic Precocious Puberty: What Parameter should be Used in Deciding on the Initial Dose?

Vurallı¹,

Alikaşifoğlu²,

Iyigun³

et al. 2020

Jcrpe

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Doses of gonadotropin releasing hormone (GnRH) analogues used to treat idiopathic central precocious puberty (iCPP) vary among clinicians. Study aims were to evaluate the efficacy of a monthly 3.75 mg dose of leuprolide acetate (LA) to suppress the hypothalamo-pituitary-gonadal (HPG) axis in girls with iCPP and to determine factors that may have an impact on the supressing dose. Methods: Study subjects were 220 girls receiving LA for iCPP. LA was started at a dose of 3.75 mg/28 days. Suppression was assessed using the GnRH test at the third month. To assess clinical suppression signs and symptoms of puberty were also evaluated. The dose of LA was increased to 7.5 mg/28 days in those who had a peak luteinising hormone (LH) ≥2 IU/L and in whom adequate clinical suppression of puberty was absent. Receiver operating characteristic curves were used to determine thresholds for clinical and hormonal factors affecting the suppressing dose of LA. Logistic regression analyses were used to investigate thresholds which might differentiate between those requiring high dose for suppression and those in whom lower dose LA was adequate. Results: Peak stimulated LH <2 IU/L was achieved in 88.6% with a dose of LA of 3.75 mg (0.11±0.03 mg/kg). Significant variables for differentiating the two doses were body weight (Wt) of 36.2 kg and/or body mass index (BMI)-standard deviation scores (SDS) of 1.64 (p<0.001). Multiple logistic regressions showed that Wt and BMI-SDS values above thresholds indicated requirement of LA at a dose of 7.5 mg/28 days (p<0.001). Conclusion: Monthly injections of 3.75 mg LA is an effective treatment in the majority of girls with iCPP. However, a higher initial dose may be preferred in patients with a Wt ≥36 kg or BMI-SDS ≥1.6 for effective suppression of the HPG axis.

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Section: Methodsmentioning

confidence: 99%

Treatment with Depot Leuprolide Acetate in Girls with Idiopathic Precocious Puberty: What Parameter should be Used in Deciding on the Initial Dose?

Vurallı¹,

Alikaşifoğlu²,

Iyigun³

et al. 2020

Jcrpe

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“…У одной пациентки с исходно нормальным показателем Э2 был повышен уровень ЛГ (7,49 мМе/мл), По данным литературы, базальный уровень ЛГ менее 0,3 мМе/мл свидетельствует об эффективности терапии препаратами агонистами ГнРГ пролонгированного действия [6].…”

Section: акт уа льностьunclassified

“…лечения Трипторелином 11,25 мг показатели длины тела матки находились в пределах 33,9 ± 5,1 мм. По данным УЗИ органов малого таза у двух девочек отмечалось увеличение длины матки на 12 и 9 мм, хотя у остальных пациенток средние показатели длины матки в группе наблюдения не превысили 34 мм, что является индикатором отсутствия гормональной стимуляции [6].…”

Section: акт уа льностьunclassified

“…Если, несмотря на проводимую терапию, пубертат прогрессирует, в зарубежных руководствах рекомендован перевод на инъекции препаратов группы агонистов ГнРГ в дозе 3,75 мг 1 раз в месяц и при отсутствии терапевтического эффекта -увеличение дозы в 2 раза -до 7,5 мг [6]. В Российских клинических рекомендациях в случае недостаточного подавления секреции гонадотропинов указано на возможность увеличения дозы препарата в 2 раза или сокращения интервала между инъекциями до 21 дня [3].…”

Section: акт уа льностьunclassified

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Experience of treatment precocious puberty by gonadotropin-releasing hormone agonists of prolonged action

et al. 2019

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Central precocious puberty (CPP) occupies an important place in the practice of pediatric endocrinologist. In the treatment of all forms of CPP, there are used drugs of GnRH (gonadotropin-releasing hormone) agonists group, whose pharmacological effect of is based on desensitization of the pituitary gland to the stimulating effect of GnRH. Therapy with agonist of gonadotropin-releasing hormone allows to stop the progression of sexual development, reduce the rate of bone maturation and, thereby, increase the final growth of the child. The article demonstrates the structure of the dispensary group of patients with CPP who were treated with the agonists GnRH of prolonged action. There has been conducted the analysis of the observation results of patients with idiopathic CPP who received 3.75 mg Triptorelin therapy in the standard regimen once every 28 days and transferred to Tryptorelin 11.25 mg once every 3 months, as well as patients with different forms of CPP with a newly established diagnosis. The presented results of treatment with 11.25 mg Triptorelin drugs by intramuscular injection in a regimen of 1 time in 3 months in comparison with the results of treatment with 3.75 mg of Triptorelin patients in the regimen of intramuscular injections once every 28 days in patients with CPP showed their effectiveness. Preparations of the agonists GnRH group of prolonged action inhibit the development of secondary sexual characteristics, lead to a decrease in the size of the internal genitalia in female and external genitalia in male and reduce the progression of bone age. It was also noted that reducing the frequency of injections of drugs of this group from 1 time in 28 days to 1 time in 3 months positively affects the emotional state of children receiving this treatment for a long period (3-6 years).

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“…15,16 As CPP is associated with a high risk of estrogen-dependent diseases, such as breast cancer and cardiovascular disease, GnRH analog treatment should be continued beyond the adequate age for patients with CPP caused by MKRN3 mutations. 17 Previous reports show that most patients with CPP caused by MKRN3 mutation who are treated with an appropriate GnRH analog seem to have satisfactorily controlled pubertal development.…”

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confidence: 99%

The first Japanese case of central precocious puberty with a novel MKRN3 mutation

et al. 2017

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MKRN3, located on chromosome 15q11.2, encodes makorin ring-finger 3, which is an upstream suppressor of the hypothalamic-pituitary-gonadal axis. Mutation of this gene induces central precocious puberty (CPP). As MKRN3 is maternally imprinted, only the paternal allele is expressed. This is the first report of an 8-year-old Japanese girl with CPP caused by a novel frameshift mutation in MKRN3 (p.Glu229Argfs*3).

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Central precocious puberty: revisiting the diagnosis and therapeutic management

Cited by 86 publications

References 60 publications

Treatment with Depot Leuprolide Acetate in Girls with Idiopathic Precocious Puberty: What Parameter should be Used in Deciding on the Initial Dose?

Treatment with Depot Leuprolide Acetate in Girls with Idiopathic Precocious Puberty: What Parameter should be Used in Deciding on the Initial Dose?

Experience of treatment precocious puberty by gonadotropin-releasing hormone agonists of prolonged action

The first Japanese case of central precocious puberty with a novel MKRN3 mutation

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