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Leuprolide and triptorelin treatment in children with idiopathic central precocious puberty: an efficacy/tolerability
M Valenzise1, C Nasso2, A Scarfone2
1Department of Human Pathology and Evolutive Age "Gaetano Barresi", University of Messina, Messina, Italy.
Insights
Gonadotropin-releasing hormone agonists (GnRHa) like leuprolide and triptorelin are effective for central precocious puberty (CPP). Both treatments show similar efficacy and tolerability, making them suitable options for managing CPP in children.
Area of Science:
- Pediatric Endocrinology
- Reproductive Medicine
- Pharmacology
Background:
- Central precocious puberty (CPP) involves early activation of the hypothalamic-pituitary-gonadal axis.
- Gonadotropin-releasing hormone agonists (GnRHa) are the standard treatment for CPP, suppressing puberty progression.
- Potential side effects and comparative efficacy of commonly used GnRHa, leuprolide and triptorelin, require investigation.
Purpose of the Study:
- To compare the efficacy and tolerability of leuprolide versus triptorelin in treating central precocious puberty (CPP).
- To evaluate clinical and radiological outcomes and assess side effect profiles of both GnRHa treatments.
Main Methods:
- A retrospective study involving 110 girls with CPP treated with either leuprolide (n=48) or triptorelin (n=62) between 2018 and 2020.
- Efficacy assessed through clinical parameters and radiological changes.
- Side effects were systematically recorded to compare the safety profiles of leuprolide and triptorelin.
Main Results:
- No significant differences in baseline characteristics except for higher LH and LH peak levels in the triptorelin group.
- Treatment durations differed significantly (leuprolide: 971 days, triptorelin: 792 days).
- Mild menopausal-like symptoms were reported by 41.8% of patients (27 triptorelin, 19 leuprolide; p=0.558), with varying specific side effects like headache and nausea. Increased initial bone age correlated with reduced side effect onset (p=0.038).
Conclusions:
- Both leuprolide and triptorelin demonstrate comparable efficacy and safety in managing central precocious puberty (CPP).
- The choice between leuprolide and triptorelin can be based on individual patient factors and physician preference.
- Further research may explore long-term outcomes and specific side effect management strategies.
Introduction:
Central precocious puberty (CPP) results from premature activation of hypothalamic-pituitary-gonadal axis, with the consequent increase of gonadotropin-releasing hormone (GnRH); GnRH agonists (GnRHa) represent the gold-standard therapy in children with CPP although their use might be responsible for pituitary GnRH receptors down-regulation, that in turn suppresses luteinizing hormone (LH) and follicle stimulating hormone (FSH) and blocks of gonadal sex hormones release. The most prescribed GnRHa in the clinical practice are leuprolide and triptorelin, whose use is generally safe and well tolerated; however, mild menopausal-like side effects could appear. The aim of the present study was to investigate and compare the efficacy and tolerability profile of leuprolide and triptorelin in CPP patients.
Methods:
110 girls affected by CPP were enrolled in this retrospective study, carried out from 2018 to 2020. The enrolled patients received leuprolide (n = 48) or triptorelin (n = 62). Efficacy was investigated by the means of clinical parameters and radiological changes and side effects were also recorded to evaluate the possible relationship between the two GnRHa treatments and side effects appearance.
Results:
At baseline triptorelin patients had significantly higher LH and LH peak levels than leuprolide patients, whereas no significant difference in other patient characteristics was observed between the two groups. The leuprolide treatment lasted 971 days [790-1,171 days] while the duration of triptorelin administration was 792 days [760-1,003 days] (p < 0.001). Overall 46 (41.8%) of the studied patients reported mild menopausal-like symptoms: among these 27 were treated with triptorelin and 19 with leuprolide (p = 0.558). Patients treated with triptorelin, or leuprolide showed headache (27.4% vs. 16.7%), mood swings (12.9% vs. 16.7%), increased appetite (12.9% vs. 18.8%) and nausea (1.6% vs. 10.4%) respectively. Moreover, the onset of side effects appearance related to GnRHa therapy significantly reduces with the increase of the initial bone age (p = 0.038).
Conclusion:
Leuprolide and triptorelin treatment appear to be effective and safe without significant difference between the two drugs in term of efficacy and tolerability, making both good options for treating CPP.
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