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Which parameters predict the beneficial effect of GnRHa treatment on height in girls with central precocious puberty?
Dogus Vuralli1, Nazli E Gonc1, Zeynep Alev Ozon1
1Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Insights
Early GnRH agonist treatment improves adult height in girls with central precocious puberty. Optimal timing and advanced bone age are key factors for height gain in iCPP patients.
Area of Science:
- Pediatric Endocrinology
- Reproductive Medicine
- Growth and Development
Background:
- Variable results exist regarding the efficacy of Gonadotropin-releasing hormone agonists (GnRHa) in improving adult height for girls with central precocious puberty (CPP).
- Idiopathic CPP (iCPP) presents a specific challenge in predicting treatment response for height optimization.
Purpose of the Study:
- To identify specific criteria that predict a beneficial height outcome from GnRHa treatment in girls with iCPP.
- To delineate optimal treatment initiation timing and patient characteristics for maximizing height gain.
Main Methods:
- Retrospective analysis of 102 girls with iCPP who reached final height after GnRHa treatment.
- Extraction and analysis of auxological, hormonal (basal estradiol), and radiological (bone age) data at treatment onset.
- Correlation of these parameters with final height (FH) and height gain (SDS).
Main Results:
- Chronological age at treatment onset was the most significant factor for height gain.
- Girls treated at or before 6.4 years achieved ≥1 SDS height gain; those treated at or after 8.3 years did not.
- For girls treated between 6.4 and 8.3 years, advanced bone age (≥2.6 years over chronological age), elevated estradiol (≥32.6 pg/ml), or pubertal stage (≥3) predicted significant height gain (≥1 SDS).
Conclusions:
- GnRHa treatment is highly effective for improving final height in girls with iCPP initiated before 6.4 years of age.
- Treatment initiated after 8.3 years may not yield significant height benefits.
- For girls aged 6.4-8.3 years, advanced bone age and pubertal development are crucial indicators for potential height gain with GnRHa therapy.
Objective:
Data about GnRHa on adult height in girls with central precocious puberty (CPP) have shown variable results, ranging from improvement of growth prognosis to lack of any benefit. This study was designed to delineate the criteria to decide which girls with idiopathic CPP (iCPP) will have a height benefit from GnRHa treatment.
Design:
Retrospective PATIENTS: 102 girls with iCPP who had reached final height (FH) were included.
Measurements:
Auxological, hormonal and radiological findings at treatment onset, and FHs were extracted from records.
Results:
Most important factor affecting height gain was chronological age (CA) at treatment onset. All the girls treated ≤6.4 years of age achieved a height gain of ≥1SDS, while none of the girls treated ≥8.3 years of age made the target. 75.6% of patients who started GnRHa between the ages of 6.4 and 8.3 years had a height gain of ≥1SDS. Most important factors affecting height gain in those treated 6.4-8.3 years were advanced bone age (BA), basal estradiol (E2 ) and pubertal stage (r2 : 0.906; P < .001). All individuals with BA advancement of ≥2.6 years or E2 of ≥32.6 pg/ml or pubertal stage of ≥3 had significant height gain, and none of the cases with BA advancement of <2 years or E2 of <21.5 pg/ml or pubertal stage of <2 had a height gain of ≥1SDS.
Conclusions:
Treatment with GnRHa is unquestionably beneficial to improve FH in girls with iCPP when initiated ≤6.4 years of age. GnRHa treatment after 8.3 years of age may not improve FH. Girls between the ages of 6.4 and 8.3 years at presentation can have a better height gain if BA (≥2.6 years over CA) and pubertal findings (pubertal stage ≥3 or E2 ≥32.6 pg/ml) are well-advanced.
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