Clinical findings influencing time to menarche post gonadotropin-releasing hormone agonist therapy in central precocious puberty

Abstract

This study aimed to evaluate the time interval to menarche after gonadotropin-releasing hormone agonist (GnRHa) treatment in females with central precocious puberty (CPP) and identify factors contributing to timing of menarche.Methods:We retrospectively reviewed medical records of 39 females with CPP who reached menarche after GnRHa treatment (leuprolide or histrelin). CPP diagnostic criteria were: breast development <8 years, pubertal luteinizing hormone and/or estradiol concentrations, and bone age advancement.Indications to treat are advanced bone age and psychosocial concerns. Descriptive summaries were reported as frequency and proportion for categorical variables and mean and standard deviation for continuous measures. Linear regression models were performed to evaluate the association between clinical factors with the time interval to menarche.Results:Mean age was 9.4±1.6 years at treatment onset and treatment duration was 2.2±1.4 years.Menarche occurred at 12.6±1.1 years, which was 1.04±0.5 years after treatment discontinuation. This was negatively associated with Tanner stage of breast development and bone age at treatment onset, and change in bone age during treatment. No association was seen between time interval to menarche and treatment duration, medication, or body mass index. Conclusions:We found the average time interval to menarche after GnRHa treatment in our population of female patients with CPP was 1.04±0.5 years and this is in agreement with other reports. Tanner stage of breast development and bone age at treatment onset, and change in bone age were negatively associated with time interval to menarche. This data provide clinical correlates that assist providers during anticipatory guidance of patients with CPP after GnRHa treatment.

Diagnostic Value of LH Peak Value of the GnRH Stimulation Test for Girls with Precocious Puberty and Its Correlation with Body Mass Index

“…Studies [ 19 ] have shown that precocious puberty is correlated with obesity, and obesity affects female hormone levels throughout preadolescence, adolescence, and adulthood. Other animal experiments [ 20 ] have shown that obesity caused by high fat diet is an important factor in inducing sexual maturity in mice.…”

Fifteen-minute consultation: The approach to the child with precocious puberty

“…Treatment in girls could be stopped at 10–11 years of age, to have menarche occurring near their peers 14. Pubertal progression usually occurs within months after the therapy discontinuation, with a mean time to menarche of 18 months 23–25. The best height outcomes are obtained when GnRH agonists are stopped when the bone age is between 12 and 12.5 years in girls, and between 13 and 13.5 years in boys 21 26…”

2022 Clinical practice guidelines for central precocious puberty of Korean children and adolescents

“…38,67,68) In girls with CPP, menarche is predicted after an average of 12 to 18 months after the completion of treatment and may begin after a few months or be delayed as long as 2 years. 58,69) It is recommended that the discontinuation of GnRH agonist treatment be decided after providing information about the FAH and pubertal progression to the guardians and patients, as well as an achievement of appropriate BA or CA.…”

“…In general, the longer the treatment period, the higher FAH, but in girls who are treated with GnRH agonist after a CA of 13 years, no further increase in FAH is observed and even a negative correlation may be shown [ 38 , 67 , 68 ]. In girls with CPP, menarche is predicted after an average of 12 to 18 months after the completion of treatment and may begin after a few months or be delayed as long as 2 years [ 58 , 69 ]. It is recommended that the discontinuation of GnRH agonist treatment be decided after providing information about the FAH and pubertal progression to the guardians and patients, as well as an achievement of appropriate BA or CA.…”