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[Predictive factors for height gain in idiopathic central precocious puberty treated with GnRH analogues]
Cristina Laguna Benetti-Pinto1, Luciana Bandeira Nunes Camargo, Luis Alberto Magna
1Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil. crislag@sigmanet.com.br
Insights
Girls with idiopathic central precocious puberty who have a greater predicted height compromise and advanced bone age benefit most from gonadotropin-releasing hormone agonist (GnRHa) treatment. These factors indicate they should not be excluded from therapy.
Area of Science:
- Pediatric Endocrinology
- Reproductive Medicine
- Growth and Development
Context:
- Idiopathic central precocious puberty (ICPP) involves early onset of puberty.
- Gonadotropin-releasing hormone agonist (GnRHa) treatment is used to halt puberty progression.
- Predicting treatment response is crucial for optimizing outcomes in ICPP.
Purpose:
- To identify predictive factors for treatment response to GnRHa in girls with ICPP.
- To evaluate the correlation between baseline characteristics and height gain during GnRHa therapy.
Summary:
- A retrospective study of 33 girls with ICPP found that predicted height compromise and bone age advancement were key predictors of height gain.
- Positive correlations were observed with time from symptom onset to treatment and bone age advancement.
- Negative correlations were found with height Z-score and predicted height at baseline, with the latter being the primary determinant of treatment gain.
Impact:
- Identifies specific patient subgroups who benefit most from GnRHa therapy.
- Informs clinical decision-making regarding treatment initiation and patient selection for ICPP.
- Highlights the importance of considering predicted adult height and bone age in managing ICPP.
Purpose:
to evaluate predictive factors of response to GnRHa treatment in girls with idiopathic central precocious puberty.
Methods:
a retrospective cohort study was conducted involving 33 girls diagnosed with idiopathic central precocious puberty and treated with GnRHa. The following independent variables were assessed: age at the beginning of therapy and at the onset of symptoms, time elapsed since the appearance of pubertal characteristics and the beginning of treatment, bone age, bone age advance, duration of GnRHa treatment, actual height and Z-score, predicted height and Z-score and hormone measurements of FSH and LH after GnRH stimulation, which were correlated with gain in height as a dependent variable at treatment discontinuation, calculated by the difference between the predicted height at the end and beginning of treatment. For statistical analysis, Pearson's linear correlation was used, in addition to multiple linear regression analysis.
Results:
the mean age at the beginning of treatment was 7.8+/-1.3 years, with a mean bone age of 10.1+/-1.6 years. Bone age advance was 2.3+/-1.1 years and was controlled during the treatment period. Gain in predicted height was 2.5+/-1.3cm. It was positively correlated with time elapsed since the beginning of symptoms and the beginning of treatment and with bone age advance, while negatively correlated with the Z-score of height at the beginning of treatment and predicted height at the beginning of treatment, and the latter was the main factor determining gain from treatment.
Conclusions:
girls who had the most significant compromise of predicted adult height, as detected by a larger deviation from the population (Z-score) and the most considerable advance in bone age, received benefit from GnRHa therapy, and they must not be excluded from the group to be treated.
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