Update on central precocious puberty: from etiologies to outcomes

Abstract

Introduction:Precocious puberty (PP) is one of the most common reasons for referral to pediatric endocrinologists worldwide. Gonadotropin-releasing hormone analogs (GnRHas) are the gold standard for the treatment of central precocious puberty (CPP) and have an impressive track record of safety and efficacy. However, ongoing refinements in diagnosis and management continue to lead to important advancements in clinical care. Areas Covered:The aim of this review is to cover current considerations and controversies regarding the diagnosis of CPP, as well as new findings in regards to etiology and treatment modalities. Expert Commentary:There is emerging evidence of monogenic etiologies of CPP and significant progress in the expansion of newer formulations of GnRHas. Despite these exciting developments, areas of uncertainty in the diagnosis and treatment of CPP remain. While long-term outcomes of patients treated for CPP are encouraging, only short-term follow-up is available with respect to the newer extended-release GnRHa preparations, and how they compare with historically used formulations is unknown. A particular shortage of information exists pertaining to CPP in boys and regarding the psychological implications of early puberty in girls, and more research is needed.Continued investigation will yield new insights into the underlying genetics and optimal treatment strategies for CPP.

Single random measurement of urinary gonadotropin concentration for screening and monitoring girls with central precocious puberty

“…The initiation of puberty requires an increase in the pulsatile release from the hypothalamus of gonadotropin-releasing hormone (GnRH), which activates the pulse generation of the gonadotropins luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in the anterior pituitary. [1][2] This is followed by gonadal growth, sex steroid production, and gametogenesis. [3][4] Because the concentrations of LH and FSH increase about 50-to 100-fold and about 10-fold, respectively, between childhood and adulthood, the serum concentrations of basal gonadotropins, especially LH, may reflect secretion occurring during pubertal development.…”

“…The three major subtypes of PP are central PP (CPP), peripheral PP, and benign pubertal variants, such as premature thelarche (PT), premature adrenarche, premature pubarche, and gynecomastia. 2) The most common form, CPP, is caused by premature maturation of the hypothalamic-pituitary-gonadal (HPG) axis. 6) The GnRH stimulation test (GnRHST) is considered the gold standard for identifying pubertal activation of the HPG axis and for diagnosing CPP.…”

Treatment of Central Precocious Puberty

“…Other genetic causes of CPP include activating mutations in kisspeptin and its receptor, KISS1R [48, 49]. However, each of these has been described as causing CPP in only a single patient thus far [50].…”

Study on the Mechanism of Sarsasapogenin in Treating Precocious Puberty by Regulating the HPG Axis

“…Although leuprolide plays a significant role in the treatment of precocious puberty, it has been found that it is easy to cause vaginal bleeding when used for the first time, with an incidence of 16%–60% [ 12 ]. Also, it can also increase the incidence of polycystic ovary syndrome [ 13 ]. In the recent years, traditional Chinese medicine has been successfully used to treat precocious puberty [ 14 ], which can achieve the purpose of delaying bone age maturity and benefit the final height of patients [ 15 ].…”