Near Final Height after GnRH Agonist Treatment in Central Precocious Puberty

Micillo, Maria; Salerno, Mariacarolina; Officioso, Annunziata; Perna, Enrico; Gasparini, N; Pisaturo, L.; Maio, Salvatore Di

doi:10.1515/jpem.2000.13.s1.787

Cited by 14 publications

(16 citation statements)

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“…Although no difference in FH between TR- and LA-treated girls was observed by Micillo et al [25], Lanes et al [19] recently reported that FH increased a mean 5.5 ± 1.3 cm over PAH in LA-treated CPP patients, while it increased 8.7 ± 2.2 cm in the TR-treated group. BA advanced 1.8 ± 0.4 years over a 2.8-year treatment period in the LA-treated group, while it advanced 1.5 ± 0.3 years in the TR-treated patients over 2.5 years of treatment, yielding no significant difference in bone maturation between GnRHa treatments [19].…”

Section: Discussionmentioning

confidence: 86%

“…Partsch et al [26] reported that initial BA advancement and treatment duration were factors that explained 68% of the variability of Ht gain, while growth after GnRHa withdrawal had no significant predictive effect on the FH. Others found that average growth rate during GnRHa treatment mainly affected Ht gain at treatment withdrawal which positively correlated to FH [24,25,26]. In our series, significant Ht difference between TR and LA treatments was achieved during but not after GnRHa treatment: similar further ΔHt increment (around 9.0 cm) after GnRHa withdrawal to FH was observed in both spCPP groups (p > 0.05; LA vs. TR group; data not shown).…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have compared GnRHa-induced hormonal patterns in children to ascertain if there is clinical equivalence between LA- and TR-based depot preparations for treatment of CPP [19,20,21,25]. Regarding gonadotropin secretion, adult studies comparing LA and TR depot preparations observed a difference in their potency and duration of action [17,18].…”

Section: Discussionmentioning

confidence: 99%

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Growth Outcome during GnRH Agonist Treatments for Slowly Progressive Central Precocious Puberty

et al. 2009

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Background: Gonadotropin-releasing hormone agonists (GnRHa) represent the gold-standard treatment for central precocious puberty (CPP). In CPP children, GnRHa treatment slows bone age progression and preserves adult height (Ht) by suppressing sexual steroid secretion. In some patients, however, GnRHa induce an inappropriate growth deceleration impairing Ht outcome. Furthermore, slowly progressive CPP (spCPP) forms were reported which do not need GnRHa treatment. Methods: We evaluated the growth outcome of 26 spCPP girls treated with triptorelin (TR) and 21 with leuprorelin acetate (LA) for 36.5 ± 0.7 months. Results: GnRHa treatment induced a progressive growth deceleration in both spCPP groups. No difference in bone maturation was detected (p > 0.05; TR vs. LA group), however compared to LA, TR treatment resulted in significantly higher Ht after 24 months (p < 0.05; LA vs. TR group). Although target height (TH) standard deviation score (SDS) and predicted adult height (PAH)-SDS at diagnosis were similar in both spCPP groups (p > 0.05; LA vs. TR group), final height (FH-SDS) was lower in LA-treated subjects (p < 0.05; LA vs. TR group). In both spCPP groups, FH-SDS was significantly lower than TH-SDS (p < 0.001) but not lower than PAH-SDS at diagnosis (p > 0.05). Ht-SDS correlated with 17β-estradiol (E₂) blood levels in both spCPP groups (p < 0.0001) throughout GnRHa treatment, and E₂ values were higher in the TR- than in the LA-treated patients during the 12 months after GnRHa administration (p < 0.05; LA vs. TR group). GnRHa-induced E₂ secretion and Ht-SDS at GnRHa withdrawal correlated positively with FH (p < 0.01 and p < 0.001, respectively). Conclusions: The effectiveness of GnRHa treatment in improving FH in spCPP girls was doubtful.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Growth Outcome during GnRH Agonist Treatments for Slowly Progressive Central Precocious Puberty

et al. 2009

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“…Porém, a experiência dos diversos grupos quanto à eficiência do tratamento na recuperação da perda estatural é bastante discrepante (25)(26)(27)(28)(29)(30). Diferenças nos resultados observados são devidas a variações das características de cada casuística, diferentes critérios de diagnóstico, idade de início e duração do tratamento, tipo de análogo empregado e variável critério para a suspensão do tratamento.…”

Section: Resultados Com O Uso De Gnrhaunclassified

Revisão crítica do diagnóstico e tratamento da puberdade precoce central

Longui

Calliari

Monte

2001

Arq Bras Endocrinol Metab

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RESUMONovos critérios para o diagnóstico e tratamento da puberdade precoce central (GnRH-dependente) têm sido propostos. O início puberal em meninas normais tem, aparentemente, ocorrido mais cedo do que o previamente descrito. Classicamente, a idade limite para o desenvolvimento puberal normal é de 9 anos nos meninos e 8 anos nas meninas. Entre 6 e 8 anos, muitas meninas apresentam sinais puberais isolados (telarca ou pubarca), associados apenas a discreto avanço da velocidade de crescimento e da idade óssea. O quadro representa uma aceleração constitucional do crescimento e puberdade e não determina perda da estatura final prevista, mesmo quando comparada ao padrão familial. Esta situação requer seguimento clínico cuidadoso, porém geralmente não necessita tratamento medicamentoso. A puberdade precoce GnRH-dependente patológica cursa com progressão dos caracteres puberais, aumento significante da velocidade de crescimento e avanço desproporcional da idade óssea, determinando redução da estatura final prevista. A idade de início é muito variável, e em parte dependente da causa do processo. Quando se manifesta entre os 6 e 8 anos de idade, apresenta caráter rapidamente progressivo. A etiologia do processo é investigada com a ressonância magnéti-ca de crânio. Deve ser tratada com agonistas hiperativos do GnRH (GnRHa), especialmente os de liberação lenta. Pode-se utilizar o leuprolide ou a triptorelina, na dose de 3,75mg, uma vez a cada 4 semanas, por via intramuscular. Habitualmente, obtém-se bom controle dos caracteres puberais. Os resultados sobre a estatura final dependem do diagnóstico e tratamento precoces, preferencialmente antes dos 6 anos de idade. Durante o tratamento com GnRHa, parte dos pacientes apresenta grande redução da velocidade de crescimento e intenso comprometimento da previsão estatural. Nesta situação, a associação com hormônio de crescimento pode ser considerada. ABSTRACTNew criteria have been proposed for the diagnosis and treatment of patients with central precocious puberty (GnRH-dependent). In girls, breast and pubic hair development are occurring significantly earlier than previously suggested. Usually, the age limit to consider puberty as normal is 9 years for boys and 8 years for girls. Several girls, between the age 6 and 8 years, show isolated pubertal characteristics (telarche or pubarche) with absent or slightly elevated growth velocity and bone age. This represents a constitutional acceleration of growth and puberty, and when compared to familial target, it presents no influence on predicted final height. Long-term clinical follow-up is recommended, but usually no treatment is required. On the other hand, pathologic GnRHdependent precocious puberty is associated to progressive pubertal manifestation, increased growth velocity and accelerated bone matu-

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“…The compromised final height and early onset of secondary sex changes tend to bring a number of psychological and behavioral issues [2] . Gonadotropin-releasing hormone agonists (GnRH-a) injected intra-muscularly every four weeks, has been widely used worldwide to suppress the secretion of sex hormones and accordingly, delay sexual development and epiphyseal fusion, resulting in elevating the adult height, as well as benefit probably psychosocial disturbances related to sexual development [3][4][5][6][7] . However, the cost and sharp pains on injection sites decline its adherence by both children and their family.…”

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confidence: 99%

Efficacy of subcutaneous administration of gonadotropin-releasing hormone agonist on idiopathic central precocious puberty

Wang

Zhang

Hou

et al. 2006

J. Huazhong Univ. Sc. Technol.

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In order to assess the feasibility of subcutaneous administration of Triptorelin with 6-week intervals for the suppression of pituitary-gonadal axis and changes of clinical signs in girls with idiopathic central precocious puberty (ICPP), 46 girls with ICPP were treated with GnRHa. Triptorelin (Decapeptyl, 3.75 mg) was administered subcutaneously (SC) at 6-weeks intervals or intramuscularly (IM) at 4-weeks intervals randomly for more than 12 months consecutively. During GnRHa therapy, clinical parameters and laboratory data, including height, weight, pubertal stage, bone age, uterine volume and ovarian size, serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and estradiol (E2), were monitored and analyzed. It was found that both treatment regimes led to regression of precocious puberty and reversal of secondary sexual characteristics. Breast developments regressed. Uterine volume was decreased after treatment, but there was no statistically significant difference. Mean ovarian volume did not change significantly during treatment. The height velocity was decreased significantly from 6.3+/-1.4 cm/year to 5.8+/-1.2 cm/year in group SC and 6.7+/-1.3 cm/year to 5.4+/-1.0 cm/year in group IM, respectively. The rate of bone maturation was reduced significantly during treatment. The ratio of deltaBA/deltaCA was 1.2+/-0.2 or 1.3+/-0.3 at the onset of therapy and decreased significantly after the treatment to 0.7+/-0.2 or 0.9+/-0.1, respectively. The predicted adult height was increased significantly and progressively during therapy. The levels of serum LH, FSH and E2 returned to the prepubertal condition. No significant side effects of therapy were noted. The most common side effect during SC treatment was that a non-irritating, 1 cm in diameter mass was palpated at the site of subcutaneous injection in the abdominal wall of patients, which disappeared after 6-12 weeks. Two girls had minimal withdrawal vaginal bleeding episodes after the first injection. It was concluded that both IM and SC triptorelin administrations were clinically effective. They induce profound suppression of hypothalamic-pituitary-gonadal axis while stabilizing height velocity, slowing bone maturation and increasing predicted adult height. These results suggest that subcutaneous injection of triptorelin in 6-weeks intervals at a dosage of 3.75 mg be a safe and acceptable regimen for ICPP

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Near Final Height after GnRH Agonist Treatment in Central Precocious Puberty

Cited by 14 publications

References 9 publications

Growth Outcome during GnRH Agonist Treatments for Slowly Progressive Central Precocious Puberty

Growth Outcome during GnRH Agonist Treatments for Slowly Progressive Central Precocious Puberty

Revisão crítica do diagnóstico e tratamento da puberdade precoce central

Efficacy of subcutaneous administration of gonadotropin-releasing hormone agonist on idiopathic central precocious puberty

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