Treatment of central precocious puberty

Area of Science:

• Pediatric Endocrinology
• Reproductive Medicine
• Pharmacology

Background:

• Central precocious puberty (CPP) presents significant challenges requiring timely intervention.
• A consensus exists among pediatric endocrinologists regarding the necessity of treating true CPP in diagnosed children.
• Treatment for children with milder forms of early puberty, not meeting formal diagnostic criteria, is generally not indicated.

Purpose of the Study:

• To review the efficacy and safety of gonadotropin-releasing hormone (GnRH) analogues for treating central precocious puberty (CPP).
• To evaluate the impact of GnRH analogue treatment on final height in girls and boys.
• To discuss current controversies regarding treatment initiation, cessation, and combination therapies.

Main Methods:

• Review of accumulated data over two decades on GnRH agonists for CPP treatment.
• Analysis of evidence regarding treatment effects on puberty suppression, final height, and adverse events.
• Examination of studies on combination therapy with growth hormone.

Main Results:

• GnRH analogues are the preferred treatment for CPP, with prolonged-acting forms being more effective and compliance-independent.
• Evidence for GnRH agonist efficacy is robust in girls but limited in boys.
• Treatment is generally safe and reversible, with well-documented final height benefits in younger girls (<6 years), some evidence in older girls (6-8 years), and no evidence in girls >8 years.

Conclusions:

• GnRH analogues are effective and safe for CPP, with early initiation maximizing potential benefits.
• Treatment cessation timing remains a subject of debate.
• While combination with growth hormone may increase final height, its clinical and economic relevance warrants further discussion, and indications need further definition.