Central Precocious Puberty: Adult Height in Girls Treated with Quarterly or Monthly Gonadotropin-Releasing Hormone Analog Triptorelin

Abstract

Background/Aims: Treatment with quarterly gonadotropin-releasing hormone (GnRH) analogs may improve compliance and optimize outcome in girls with central precocious puberty (CPP), but long-term comparative data between the new and the monthly formulations are very scarce. Methods: A group of girls with idiopathic CPP (n = 13; age 7.9 ± 0.6 years) were treated from the beginning with quarterly triptorelin (11.25 mg/90 days) and followed up to the achievement of adult height (AH). A group of girls with idiopathic CPP (n = 12; age 8.0 ± 0.6 years) treated with monthly triptorelin (3.75 mg/28 days) served as controls. Results: The AH (157.1 ± 4.9 cm) of girls treated with quarterly triptorelin was not significantly different from their mid-parental height (159.7 ± 3.8 cm) and significantly increased in comparison with predicted AH (average tables) at the beginning of GnRH analog therapy. The AH of girls treated with quarterly triptorelin was not significantly different in comparison with that of girls treated with the monthly formulation (158.1 ± 6.6 cm; mid-parental height 158.4 ± 5.0 cm). Conclusion: Treatment with quarterly triptorelin formulation permitted to achieve an AH adequate for mid-parental height in girls with CPP. Significant differences of AH between girls with CPP treated with quarterly or monthly formulations were not found.

A Critical Appraisal of the Effect of Gonadotropin-Releasing Hormon Analog Treatment on Adult Height of Girls with Central Precocious Puberty

“…In terms of effcicacy of treatment, various GnRHa appeared similar as regards to height outcome ( 26 , 62 , 71 , 74 ), except for a study ( 69 ) demonstrating slightly better adult height SDS in patients treated with leuprolide depot compared to triptorelin depot.…”

“…Comparison of final height of treated patients with their TH eliminates the handicaps of predicting adult heigt thus allows perhaps a better estimation of the effect of GnRHa treatment on height. When compared to TH, in most studies (nineteen studies), final height was 0.4 to 5.2 cm shorter than TH ( 15 , 16 , 20 , 28 , 47 , 54 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 74 ) but 0.4-4.2 cm taller in the remaining nine studies ( 17 , 22 , 23 , 55 , 56 , 59 , 72 , 73 , 75 ). On average, final height was ~1 cm shorter than TH.…”

“…As a result of the progressive normalization of BA, and continued linear growth, treatment provides increase in PAH despite the decreased growth velocity, although it is difficult to predict precisely the effect of GnRHa treatment on height gain of these patients, due to handicaps discussed above. Reviewing the available 28 studies on GnRHa treatment of CPP ( 7 , 15 , 16 , 17 , 20 , 22 , 23 , 28 , 47 , 54 , 55 , 56 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ) ( Table 6 ) and our own experience ( 75 ) demonstrate that the mean age at onset of pubertal development ranged 3-8 years, usually younger and more severe cases in older studies, older and milder cases in recent studies. Nevertheless, in most series, the age of treatment initiation was around 7 years, (5.4-8.7 years) with again recent studies tend to be a year later around 7.5-8 years.…”

Avaliação de pacientes com puberdade precoce central após o tratamento com análogos de GnRH: aspectos antropométricos, metabólicos, reprodutivos e psicossociais

“…O acetato de leuprorrelina e a triptorrelina de uso mensal (dose de 3,75 mg ou 7,5 mg) ou trimestral (11,25 mg) são os análogos de GnRH mais utilizados para bloqueio puberal (34). Ao contrário das inúmeras publicações sobre os efeitos em curto e longo prazo do tratamento da PPC com aGnRH de uso mensal, os resultados de curto e longo prazo do tratamento da PPC com aGnRH de posologia trimestral são escassos (35)(36)(37).…”

“…Um efeito colateral de particular importância é a reação alérgica local, que resulta na formação de um abscesso estéril que impede a absorção do aGnRH e falha na supressão hormonal (32). Nestes casos, geralmente o tratamento é interrompido e outras opções secundárias para o bloqueio puberal, tais como acetato de medroxiprogesterona ou acetato de ciproterona, são utilizadas (36,39,40).…”