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Growth outcome during GnRH agonist treatments for slowly progressive central precocious puberty
Francesco Massart1, Giovanni Federico, Joshua Chuck Harrell
1Pediatric Endocrine Center, Department of Pediatrics, University of Pisa, Pisa, Italy. massart@med.unipi.it
Insights
Gonadotropin-releasing hormone agonists (GnRHa) treatment for slowly progressive precocious puberty (spCPP) in girls showed questionable effectiveness in improving final height. Triptorelin resulted in better height outcomes than leuprorelin acetate, despite both causing growth deceleration.
Area of Science:
- Pediatric Endocrinology
- Reproductive Medicine
- Growth and Development
Background:
- Gonadotropin-releasing hormone agonists (GnRHa) are standard for central precocious puberty (CPP), preserving adult height by suppressing sex steroids.
- However, GnRHa can cause detrimental growth deceleration in some CPP patients.
- Slowly progressive CPP (spCPP) variants exist, potentially not requiring GnRHa treatment.
Purpose of the Study:
- To evaluate and compare the growth outcomes of spCPP girls treated with triptorelin (TR) versus leuprorelin acetate (LA).
- To assess the impact of GnRHa on final height (FH) in spCPP patients.
- To investigate the relationship between 17beta-estradiol (E2) levels and height outcomes during GnRHa treatment.
Main Methods:
- Retrospective analysis of 26 spCPP girls treated with triptorelin and 21 with leuprorelin acetate for approximately 36.5 months.
- Growth parameters, bone maturation, target height (TH), predicted adult height (PAH), and final height (FH) were assessed.
- 17beta-estradiol (E2) levels were monitored throughout GnRHa treatment.
Main Results:
- GnRHa treatment led to progressive growth deceleration in both spCPP groups.
- Triptorelin treatment resulted in significantly higher final height compared to leuprorelin acetate after 24 months and at final height (FH-SDS).
- Estradiol levels correlated with height SDS during treatment, with higher E2 levels observed in the triptorelin group.
Conclusions:
- The effectiveness of GnRHa treatment in improving final height in spCPP girls is questionable.
- Triptorelin may offer better height outcomes than leuprorelin acetate in spCPP girls, potentially due to differences in E2 suppression.
- Further research is needed to optimize GnRHa treatment strategies for spCPP to balance pubertal suppression and growth preservation.
Background:
Gonadotropin-releasing hormone agonists (GnRHa) represent the gold-standard treatment for central precocious puberty (CPP). In CPP children, GnRHa treatment slows bone age progression and preserves adult height (Ht) by suppressing sexual steroid secretion. In some patients, however, GnRHa induce an inappropriate growth deceleration impairing Ht outcome. Furthermore, slowly progressive CPP (spCPP) forms were reported which do not need GnRHa treatment.
Methods:
We evaluated the growth outcome of 26 spCPP girls treated with triptorelin (TR) and 21 with leuprorelin acetate (LA) for 36.5 +/- 0.7 months.
Results:
GnRHa treatment induced a progressive growth deceleration in both spCPP groups. No difference in bone maturation was detected (p > 0.05; TR vs. LA group), however compared to LA, TR treatment resulted in significantly higher Ht after 24 months (p < 0.05; LA vs. TR group). Although target height (TH) standard deviation score (SDS) and predicted adult height (PAH)-SDS at diagnosis were similar in both spCPP groups (p > 0.05; LA vs. TR group), final height (FH-SDS) was lower in LA-treated subjects (p < 0.05; LA vs. TR group). In both spCPP groups, FH-SDS was significantly lower than TH-SDS (p < 0.001) but not lower than PAH-SDS at diagnosis (p > 0.05). Ht-SDS correlated with 17beta-estradiol (E(2)) blood levels in both spCPP groups (p < 0.0001) throughout GnRHa treatment, and E(2) values were higher in the TR- than in the LA-treated patients during the 12 months after GnRHa administration (p < 0.05; LA vs. TR group). GnRHa-induced E(2) secretion and Ht-SDS at GnRHa withdrawal correlated positively with FH (p < 0.01 and p < 0.001, respectively).
Conclusions:
The effectiveness of GnRHa treatment in improving FH in spCPP girls was doubtful.
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