Treatment of central precocious puberty by GnRH analogs: long-term outcome in men

Abstract

In boys, central precocious puberty (CPP) is the appearance of secondary sex characteristics driven by pituitary gonadotropin secretion before the age of 9 years. In the last years, relevant improvements in the treatment of CPP have been achieved. Because CPP is rare in boys, the majority of papers on this issue focus on girls and do not address specific features of male patients regarding end results and safety. In the present paper, recent advances of CPP management with GnRH analogs in men are summarized. End results in untreated and treated patients are also reviewed by an analysis of the recently published literature on treatment of CPP in men. The available data indicate that therapy with GnRH analogs can improve final height into the range of target height without significant adverse short-term and long-term effects, but longer follow-up of larger series of patients is still required to draw definitive conclusions.

The use of GnRH agonists in precocious puberty

“…An analysis of final height from 11 studies showed a remarkably varied mean height gain of K1.8 to 15.0 cm (29). The variability must be explained, in part, by the small numbers in most of the study groups, but an analysis of 26 boys from three European studies showed a height gain of 6.2 cm (S.D.…”

“…Comparing historical with contemporary data may be affected by the influence of secular trends in human growth over the past 25 years. Many studies have had to rely on height prediction, rather than actual final height, to evaluate the effect of treatment intervention (29). The use of bone ages is insufficiently reliable, particularly when skeletal maturation is markedly advanced at presentation.…”

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

“…Historical data on untreated patients with CPP show mean final heights ranging from 151 to 156 cm in boys and from 150 to 154 cm in girls, being the height loss inversely correlated with the age at the onset of puberty (2,6).…”

“…Treatment is aimed at selectively and effectively suppressing gonadal steroid secretion through medical treatment or removing the underlying cause whenever possible to allow normal sexual maturation and statural growth (2,3,6). The avoidance of potential psychosocial problems derived from experiencing precocious puberty and undesirable behaviors like early sexual intercourse and substance abuse reported in some cohorts of patients may also be acknowledged as objectives of the treatment (2,3,7).…”

“…Depot formulations are generally preferred because of better patient compliance. Drug choice depends on physician experience, patient needs, and government regulations of drug prescription (6,7). GnRHa is generally safe and well tolerated.…”