MANAGEMENT OF ENDOCRINE DISEASE: Long-term outcomes of the treatment of central precocious puberty

Abstract

GnRH analogues (GnRHa) are the treatment of choice for central precocious puberty (CPP), with the main objective to recover the height potential compromised by the premature fusion of growth cartilages. The aim of this review was to analyze longterm effects of GnRHa on height, body weight, reproductive function, and bone mineral density (BMD) in patients with CPP, as well as the potential predictors of outcome. Because randomized controlled trials on the effectiveness and long-term outcomes of treatment are not available, only qualified conclusions about the efficacy of interventions can be drawn. GnRHa treatment appears to improve adult height in girls with CPP, especially if diagnosed before the age of 6, whereas a real benefit in terms of adult height is still controversial in patients with the onset of puberty between 6 and 8 years of age. No height benefit was shown in patients treated after 8 years. Gonadal function is promptly restored in girls after cessation of treatment, and reproductive potential appears normal in young adulthood. Data are conflicting on the long-term risk of polycystic ovarian syndrome in both treated and untreated women. Fat mass is increased at the start of treatment but normalizes thereafter, and GnRHa itself does not seem to have any long-term effect on BMI. Similarly, analogue treatment does not appear to have a negative impact on BMD. Owing to the paucity of data available, no conclusions can be drawn on the repercussions of CPP and/or its treatment on the timing of menopause and on the health of the offspring.

One-Year Follow-Up of Girls with Precocious Puberty and Their Mothers: Do Psychological Assessments Change over Time or with Treatment?

“…In contrast, others have failed to find any differences in self-image, self-esteem, or behavior in children with precocious puberty when compared to population norms [29, 30], Interestingly, one study even reported higher verbal IQ in a mixed group of girls with precocious puberty or PA compared with a control group with normally timed development [31]. Thus, this area has been identified as one that is sorely in need of additional research [32] and it is probably not a coincidence that literature reporting long-term outcomes of GnRHa therapy for CPP generally neglect psychological aspects of follow-up entirely [33–35]. Clearly, more information regarding this topic is essential.…”

Growth Hormone Improves Short-Term Growth in Patients with Temple Syndrome

“…Precocious puberty, which promotes an early pubertal growth spurt and skeletal maturation, causes bone age acceleration and contributes to short stature in patients with Temple syndrome [4, 14, 15]. As a result, some of these patients are treated with long-acting gonadotropin-releasing hormone (GnRH) analogue to delay puberty [4, 8, 13, 16].…”

Change in body mass index and insulin resistance after 1-year treatment with gonadotropin-releasing hormone agonists in girls with central precocious puberty

“…Laboratory confirmation for the diagnosis of central precocious puberty (CPP) is a maximal concentration of luteinizing hormone (LH) ≥5 IU/L after GnRH stimulation testing3). A depot formulation of GnRH agonist (GnRHa) has been used for the suppression of the HPG axis in subjects with CPP45).…”