Effect of Cyproterone Acetate (Ca) on Growth and Endocrine Function in Precocious Puberty

Abstract

Abstract. Stahnke, N., Ilicki, A. and Willig, R. P. (Department of Paediatrics, University Hospital, Hamburg, West Germany). Effect of cyproterone acetate (CA) on growth and endocrine function in precocious puberty. Acta Paediatr Scand, Suppl. 277: 32, 1979.–16 girls with precocious puberty have been studied. Following low dosage cyproterone acetate (CA) therapy (mean daily dosage 65 mg/m2 BSA) a beneficial effect on growth and skeletal maturation was observed. During high dosage therapy (150 mg/m2 per day) endocrinological studies were performed in 10 of these patients. There was no significant difference in HGH levels (insulin‐and arginine‐test), T3 and TSH values (TRH‐test) between patients and controls, T4 concentration was significantly increased. Basal prolactin levels and prolactin response to TRH was definitely elevated. Oral glucose load and arginine infusion resulted in a significantly enhanced insulin release. There was a significant reduction in basal LH levels and an increase in FSH response to LH‐RH. Basal and diurnal plasma cortisol values were markedly reduced and the cortisol release due to corticotrophin injection, (lsinevasopressin (LVP) injection and insulin‐hypoglycemia as well. A definite increase in basal ACTH levels was observed, during LVP‐and insulin‐hypoglycemia test ACTH concentrations were within or significantly above normal range. In our patients a primary adrenocortical insufficiency due to CA treatment was evident.

Prolactin response to thyrotropin-releasing hormone in children with gynecomastia, premature thelarche and idiopathic precocious puberty.

“…This suggests that CA may exaggerate the PRL responsiveness to TRH and may operate at the hypothalamus or pituitary gland as a stimulatory agent of PRL release. This is in agreement with the finding that PRL secretion in response to TRH was enhanced in patients given CA, but not with the finding that the administration of CA resulted in a significant elevation in baseline level of plasma PRL (Fonzo et al 1977 ;Stahnke et al 1980). This discrepancy may be explained by differences in doses of CA administered and the duration of treatment with CA between their patients and ours.…”

The effect of cyproterone acetate on the growth of children with central precocious puberty

“…Because of the sex incidence of central precocious puberty, most of the evidence for the support of a beneficial effect of cyproterone acetate on growth has been accumulated in girls. The initial rise in growth potential of untreated girls with central precocious puberty probably accounts for the early reports of the beneficial effect of cyproterone acetate [1,2,11,18,20] and emphasises that long treatment periods must be used in order to assess an effect on growth potential. There was no significant difference between height SDS for bone age at the beginning and end of observation in either treated or untreated groups.…”

“…There has been considerable controversy about the effect of cyproterone acetate on the growth of children with central precocious puberty. In this respect it has been claimed that cyproterone acetate improved growth prognosis [1,2,18,20], improved growth prognosis if the bone age was less than 11 "years" [11] and alternatively had no effect on growth prognosis [29].…”

The long-term effect of cyproterone acetate on growth in girls with idiopathic precocious puberty

“…It is generally accepted that CPA is effective for the arrest of the development of secondary sexual characteristics. However, there has been considerable controversy about the effect on improvement in stature [11,17,18,201 .…”