Importance of individualizing treatment decisions in girls with central precocious puberty when initiating treatment after age 7 years or continuing beyond a chronological age of 10 years or a bone age of 12 years.

Marcela Vargas Trujillo,Sanja Dragnic,Karen O Klein,Petra Aldridge

doi:10.1515/jpem-2021-0114

Abstract

Gonadotropin-releasing hormone agonist treatment is important for optimal growth in girls with central precocious puberty (CPP). Data are lacking regarding benefit to height outcome when treatment is started after chronological age (CA) of 7 years, and if continued beyond CA of 10 years or bone age (BA) of 12 years. Forty-eight girls with CPP were treated with monthly leuprolide depot. Change in predicted adult height (PAH) during treatment was assessed. Changes in PAH and growth velocity were compared between girls initiating treatment at CA <7 vs.≥7 years, and BA≥12 vs. BA <12 years. Mean baseline CA was 6.8 years, BA, 10.2 years; and PAH, 156.4cm. BA/CA ratio decreased from pretreatment values, averaging 1.5 to 1.2at the end of treatment. Proportion of girls with >5cm PAH change during treatment was similar, and PAH increased throughout treatment in most girls, regardless of age at treatment initiation. PAH continued to increase in 16/19 girls who continued treatment after BA of 12 years, and also in 16/22 girls who continued treatment after CA of 10 years. PAH improved in most girls who initiated treatment after CA of 7 years. It continued to improve in most girls with longer treatment, even past BA of 12 years or CA of 10 years, which suggests that no absolute CA or BA limit should define initiation or end of treatment. Treatment plans need to be individualized, and neither treatment initiation nor cessation should be based on BA or CA alone.

Highlights

Central precocious puberty (CPP) occurs when the hypothalamic-pituitary-gonadal axis is prematurely activated, leading to an increase in gonadal steroid hormone secretion [1]
The present study addresses two key areas regarding height outcome after gonadotropin-releasing hormone agonist (GnRHa) treatment in girls with central precocious puberty (CPP)
One is whether there is additional height gain when continuing treatment after a bone age (BA) of 12 years, and the other is whether there is height gain when onset of treatment is at chronological age (CA)>7 years

Summary

Introduction

Central precocious puberty (CPP) occurs when the hypothalamic-pituitary-gonadal axis is prematurely activated, leading to an increase in gonadal steroid hormone secretion [1]. It has been suggested that there is no further benefit to height outcome when treatment is continued after a bone age (BA) of 12 years [8,9,10,11,12], and there are conflicting reports on whether there is benefit from starting treatment at chronological age (CA) ≥7 years [2, 4, 13,14,15,16,17]. There is high variability in the increases in adult height, which is dependent on the age of the child at the time of treatment initiation [16]. Adult height outcome is multifactorial and the present analysis was conducted to assess whether girls diagnosed with CPP receive adult height benefit from GnRHa treatment when

Objectives

Methods

Conclusion