Long-term results with a slow-release gonadotrophin-releasing hormone agonist in central precocious puberty. Dutch-German Precocious Puberty Study Group
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W Oostdijk1, S L Drop, R J Odink
1Department of Paediatrics, Universities of Leiden, Rotterdam, The Netherlands.
Insights
Treatment with triptorelin, a gonadotrophin-releasing hormone (GnRH) agonist, for central precocious puberty (CPP) improved predicted adult height in children. Continued treatment is advised for optimal auxological outcomes.
Area of Science:
- Pediatric Endocrinology
- Reproductive Medicine
- Growth and Development
Background:
- Central precocious puberty (CPP) involves early onset of puberty, leading to potential long-term growth issues.
- GnRH agonist therapy is a standard treatment for CPP, but optimal duration and outcomes require further study.
Purpose of the Study:
- To evaluate the long-term effects of triptorelin treatment on growth and predicted adult height in children with CPP.
- To assess the impact of treatment cessation on growth velocity and pubertal development.
- To investigate the efficacy of concomitant growth hormone (GH) therapy in select cases.
Main Methods:
- An international multicentre study involving 19 children (14 girls, 5 boys) with CPP treated with triptorelin for 4 years.
- Analysis of height velocity, predicted adult height, and timing of menses after treatment cessation in a subset of patients.
- Initiation of GH therapy in three girls with suboptimal growth response to triptorelin alone.
Main Results:
- Triptorelin treatment stabilized height velocity and significantly increased predicted adult height in both girls and boys.
- Discontinuation of triptorelin led to the onset of menses and a transient increase in height velocity, but no significant improvement in predicted adult height.
- Concomitant GH therapy in select patients markedly increased height velocity and improved predicted adult height.
Conclusions:
- Prolonged triptorelin treatment is recommended for optimal auxological outcomes in children with CPP.
- Growth hormone therapy can be beneficial for children with CPP who have suboptimal growth response to GnRH agonist therapy alone.
Abstract:
As part of an ongoing international multicentre study, 19 children (14 girls, 5 boys) with central precocious puberty (CPP) were treated with a slow-release gonadotrophin-releasing hormone (GnRH) agonist, triptorelin, for 4 years. After 3 years of treatment, height velocity stabilized at 4.0 cm/year. Predicted adult height (mean +/- SD) increased from 158.9 +/- 6.8 to 164.9 +/- 6.6 cm in girls (n = 14, p less than 0.01), and from 174.4 +/- 18.5 to 184.3 +/- 17.1 cm in boys (n = 4, p less than 0.05). In 12 additional girls who had started the multicentre study but discontinued triptorelin treatment after 2.2 +/- 0.5 years, menses started 9.8 +/- 3.7 months after cessation of treatment in all but one patient. Height velocity increased over the first 6 months after discontinuation of treatment, from 3.6 +/- 0.1 to 5.4 +/- 2.5 cm/year, and remained higher than pretreatment values in the second 6 months, but decreased subsequently. Bone maturation increased, and no significant improvement in predicted adult height was observed. For auxological reasons, therefore, it may be advisable to continue triptorelin treatment for as long as possible. Concomitant growth hormone (GH) therapy was initiated in three girls with CPP with height velocities of 3.2-3.6 cm/year after 3 years of treatment with triptorelin and predicted adult heights of less than the third centile for Dutch girls. Prior to the administration of GH, all patients had subnormal 24-hour GH profiles and GH responses to arginine provocation. GH treatment increased height velocity markedly in all girls, and improved predicted adult height.(ABSTRACT TRUNCATED AT 250 WORDS)