Growth, Bone Maturation and Height Prediction after Three Years of Therapy with the Slow Release GnRH-Agonist Decapeptyl-Depot in Children with Central Precocious Puberty

Abstract

More than 100 patients with central precocious puberty are participating in this international multicenter study using monthly i.m. injections of the slow-release GnRH agonist Decapeptyl-Depot. In 15 patients, Decapeptyl-Depot treatment could be discontinued after 2 years of therapy. Gonadal suppression was promptly reversible in all of them, as shown by prepubertal low gonadotrophin- and sex steroid levels. Of the remaining 90 patients, 40 have been treated for more than 3 years, including 33 girls and 7 boys. Plasma levels of LH, FSH, estradiol and testosterone dropped to the prepubertal range after one month of Decapeptyl-Depot and remained there for the whole period of therapy. At start of therapy, mean chronologic age of these 40 children was 6.6 +/- 1.4 (SD) years, mean bone age 10.2 +/- 1.9 years. Mean predicted adult height increased in the boys from 173.6 +/- 13.8 (SD) cm at start of therapy to 184.6 +/- 17.0 cm after 3 years. Predicted adult height increased in girls from 158.0 +/- 12.2 to 161.0 +/- 7.5 cm. Undue side effects were not seen, long term tolerance was good. It is concluded that Decapeptyl-Depot injected i.m. every 4 weeks suppresses the pituitary-gonadal axis in children with central precocious puberty without clinical or biochemical escapes, and leads to an increase in predicted adult height by more than 3 cm in all boys and in 53% of the girls after three years of treatment.

Analysis of the factors affecting auxological response to GnRH agonist treatment and final height outcome in girls with idiopathic central precocious puberty

“…Their FH, in fact, was on average 2.8 cm higher with respect to PH1, but 1.8 cm lower than PH2; consequently almost half of the gain in PH during treatment was lost between the time therapy was stopped and the time adult height was reached. A similar trend has been described by other authors (11,(16)(17)(18)(19) and is probably due to the significant increase of DBA:DCA ratio which has been reported to follow therapy cessation (16,19).…”

Auxological and Biochemical Evaluation of Pubertal Suppression with the GnRH Agonist Leuprolide Acetate in Early and Precocious Puberty

“…Cook et al [10]suggest that overnight monitoring of LH release is more sensitive than GnRH stimulation testing. These authors and others [11, 12]also stress the importance of clinical regression of pubertal characteristics and decrease in skeletal maturation rate.…”

Gonadotropin-Releasing Hormone Analogue Treatment for Precocious Puberty

“…The most widely used drugs are triptorelin depot [9,10,130,131] and leuprorelin depot [132][133][134][135]. Both leuprorelin depot and triptorelin depot were initially applied intramuscularly; however, these injections were very painful for the patients.…”

“…After the introduction of short-acting GnRH agonists for the suppressive therapy of central precocious puberty (CPP) in 1981 [8], depot preparations of GnRH agonists have been available since the mid-1980s and have become the treatment of choice for CPP [9,10]. Their suppressive effect on the pituitarygonadal axis has been well documented, and its reversibility has been demonstrated [11,12].…”