Adult height comparison between boys and girls with precocious puberty after long‐term gonadotrophin‐releasing hormone analogue therapy

Abstract

Adult height comparison between boys and girls with precocious puberty after long-term gonadotrophin-releasing hormone analogue therapy. Acta Paediatr 1998; 87: 521-7. Stockholm. ISSN 0803-5253 We examined 22 girls and 11 boys with idiopathic precocious puberty (IPP) treated with a GnRH analogue for a period of about 4 y. The purpose of our study was to evaluate possible differences between the two sexes in bone growth and skeletal maturation during treatment and in the achievement of final height, and also to study the relative contribution of particular hormones-sex steroids, DHEAS, GH and IGF-I-during the pubertal growth spurt. At the beginning of therapy mean chronological age (CA) was 7.61 Ϯ 0.84 y in boys and 7.32 Ϯ 1.06 y in girls. After the first year of treatment, growth velocity and Dbone age/Dchronological age (DBA/DCA) ratio had declined significantly in both groups. At the end of therapy we observed a statistically relevant increase in predicted adult height in both sexes, with a more appreciable mean gain (expressed as SDS) being achieved by male patients. During the first year following discontinuation of treatment, a significant increase in the DBA/DCA ratio was observed in both males and females; by contrast, growth velocity increased only in male patients. Adult height SDS was thus greater in boys (0.13 Ϯ 0.91) than in girls (−0.62 Ϯ 0.88, p Ͻ 0:05). With regard to endocrinological data, oestradiol and testosterone were significantly reduced during the first year of therapy, while DHEAS levels increased slightly in both sexes throughout the course of treatment. GH peak after clonidine and IGF-I concentrations remained unchanged in both groups. Also, a study of nocturnal GH secretion (10 subjects) showed no noteworthy decrease in any of the patients, whether in terms of mean GH, of the sum of pulse amplitudes, or of pulse frequency. In conclusion, our data indicate that boys achieve more significant results in terms of adult height than girls. With reference to endocrinological data, the effect of sex steroids on bone maturation seems to be more significant than previously thought, and we hypothesize a different role for androgens and oestrogens in regulating height velocity and bone maturation in both male and female subjects during pubertal growth spurt. ٖ Adult height, GnRH analogue, growth hormone, idiopathic precocious puberty, sex steroids

Treatment of central precocious puberty by GnRH analogs: long-term outcome in men

“…In Europe, the 11 boys reported by Galluzzi et al [24], all with idiopathic CPP and treated with triptorelin depot, showed a final height exceeding the initial prediction by 6.7 cm and were close to target height (Table 4). In subsequent studies from Europe, Israel, and India, all using triptorelin depot, the adult height was greater than the target height [23,[44][45][46].…”

“…In Europe, triptorelin depot is widely used at 28 day intervals [15,[22][23][24][25], even though some authors have reported shorter frequency intervals of administration (21-26 days) [26][27][28]. It is usually administered at a dose of 3.75 mg (approximately 60-75 μg/kg) for children weighting more than 20 kg [22][23][24][25]; a half dose has been employed in patients weighting less than 20 kg [23]. Some authors have used higher doses (90-100 μg/kg) [28,29].…”

“…In boys, post-treatment growth is highly correlated with bone age at discontinuation of treatment [16]. In boys with normal onset of puberty height, velocity peaks around the chronological age of 13.5-14 years [14]; the discontinuation of treatment at a bone age close to peak height velocity might improve adult height [24].…”

Normal and Abnormal Puberty

“…Although it has been suggested that treatment with GnRHa improves final adult height, the evidence points more to the age at the onset of treatment as the crucial factor [113][114][115], with a more clearcut effect in younger children. Data on final height suggest that treatment with GnRHa analogs and cyproterone acetate cannot recover lost height potential, and children cannot attain their target mid-parental height [116,117].…”

“…However, withdrawal of sex steroids due to GnRHa results in a reduction in bone mineral density [122,123], although there are no long-term data on how this translates into long-term bone health [115]. Sex steroid withdrawal in children can result in "menopausal" symptoms, such as hot flushes and mood swings, occasionally necessitating low-dose estrogen therapy.…”