Gonadotropin-Releasing Hormone Analogue Treatment for Precocious Puberty

Abstract

Central precocious puberty (CPP) is the premature onset of puberty due to a precocious activation of gonadotropin-releasing hormone (GnRH) neurons in the hypothalamus. This condition results in accelerated development of secondary sex characteristics, accelerated bone maturation, impaired final height with disproportioned body appearance and can have a disturbing impact on the psychosocial behavior of children suffering from CPP. It is therefore necessary to assess the hormonal status of children who show pubertal signs before the age 8 years in girls and 9 years in boys. The indication for treatment should be made after evaluating pubertal progression, progression of bone age maturation and final height prognosis, development of reproductive function, and psychosocial adjustment and well-being. This paper summarizes the experience of GnRH agonist treatment, which is momentarily the treatment of choice for central precocious puberty in children.

Central precocious puberty: revisiting the diagnosis and therapeutic management

“…2016;60/2 characteristics, delay the skeletal maturation, preserve the normal height potential (within the range of the target height), avoid body disproportions, and promote the psychosocial adjustment of the patient and his or her family. It also helps to prevent pregnancy at an early age, and reduce the risk of sexual abuse, early initiation of sexual activity, and estrogen-dependent cancer (mainly breast cancer) related to the occurrence of early menarche (10,44,46). Pubertal arrest is indicated in patients with progressive precocious puberty of any etiology, accelerated pubertal development (progression from one pubertal stage to another in a shorter period than normal), potential of abnormal final stature [prediction of final height below the 2.5 th percentile; prediction of final height below the target height (± 8.5 cm); height SD for BA below -2; loss of height potential during follow-up (44)].…”

“…GnRHa acts on the anterior pituitary, competing for GnRH receptor with endogenous GnRH, promoting endocytosis and reducing the amount of GnRH receptors ("down-regulation") (46)(47)(48). Initially, GnRHa stimulates the synthesis and secretion of LH and FSH but when it is administered chronically, GnRHa suppresses the production of these hormones, which in turn suppress the production of sex steroid hormones by the gonads (28,48).…”

“…Treatment withdrawal should take into account the chronological age of the patient and his or her psychosocial adequacy and desire. A BA around 12.5 years in girls and 13.5 years in boys indicate the best moment to withdraw the therapy aiming at reaching a normal final height within the genetic potential (10,15,44,46).…”

“…Evidence shows that the GnRHa treatment is beneficial in preserving the potential genetic height, mainly in those girls who started treatement before 6 years of age (42,44,46,47). Conversely, CPP diagnosed after the age of 6 yr had reduced post treatment height gain and compromised final height, probably due to pre treatment intrinsic changes in the growth plate according Lazar and cols.…”

Sexuality of Children and Adolescents With Developmental Disabilities

“…Gonadotropin-releasing hormone agonists can effectively manage true central precocious puberty in most females. 10 All females deserve appropriate gynecologic care, including children and adolescents with developmental disabilities. During the first 2 years after menarche, anovulatory menstrual cycles are generally associated with abnormal uterine bleeding; however, thyroid disease, anticonvulsant therapy, and neuroleptic medications may also contribute to these symptoms.…”