Improved final predicted height with the injection of leuprolide in children with earlier puberty: A retrospective cohort study.

Yi-Chun Lin,Chiu-Ying Chen,Chung-Hsing Wang,Fuu-Jen Tsai,Chih-Ying Lin,Hung-Rong Yen,Siew-Yin Chee,Hubert Vaudry

doi:10.1371/journal.pone.0185080

Yi-Chun Lin, Chiu-Ying Chen + Show 6 more

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https://doi.org/10.1371/journal.pone.0185080

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Abstract

The adult height of children with early onset puberty is limited by the premature maturation of hypothalamic-pituitary-gonadal axis. To evaluate the effects of gonadotropin-releasing hormone analog (GnRHa) treatment on the final height (FH) and bone maturation rate (BMR) in girls with early puberty (EP) or idiopathic central precocious puberty (ICPP), we examined data from girls who were diagnosed with EP or ICPP and underwent GnRHa (Leuplin Depot: 3.75 mg/month) at China Medical University Hospital, in Taiwan, between 2006 and 2015. Patients were observed until the achievement of FH and divided into an “EP group” (T-ep) and “ICPP group” (T-icpp) according to the age of onset of puberty. Eighty-seven patients were enrolled (T-ep, N = 44, puberty onset at 8–10 years; T-icpp, N = 43, puberty onset before 8 years). The demographic data of girls with EP or IPP was characterized. BMR, change in predicted final height (PFH) after GnRHa treatment, target height (TH) and FH were measured. After GnRHa treatment, the study groups (T-ep: 160.24±6.18 cm, T-icpp: 158.99±5.92 cm) both had higher PFH than at initiation (T-ep: 159.83±7.19 cm, T-icpp: 158.58±5.93 cm). There was deceleration of BMR in both groups (T-ep: 0.57±0.39; T-icpp: 0.97±0.97) and a significant difference between the groups (p = 0.027). The gap in FH standard deviation scores (SDS) and TH SDS had a significant difference in T-ep (p = 0.045) but not in T-icpp. Moreover, there was no difference in the gap of PFH SDS between the 1st and final treatment in both groups. We concluded that GnRHa decelerated BMR in girls with earlier puberty. Further prospective clinical studies are warranted.

Highlights

Puberty marks the end of childhood and is a period when individuals undergo physiological and psychological changes to achieve sexual maturation and fertility [1]
To evaluate the effects of gonadotropin-releasing hormone analog (GnRHa) treatment on the final height (FH) and bone maturation rate (BMR) in girls with early puberty (EP) or idiopathic central precocious puberty (ICPP), we examined data from girls who were diagnosed with EP or ICPP and underwent gonadotropin-releasing hormone analogues (GnRHa) (Leuplin Depot: 3.75 mg/month) at China Medical University Hospital, in Taiwan, between 2006 and 2015
Earlier puberty includes precocious puberty (PP) and early puberty (EP); PP is defined by the appearance of the secondary sexual characteristics before the age of 8 in girls and 9 in boys, whereas EP defined by the appearance of the secondary sexual characteristics between the age of 8 and in girls and 9 and in boys

Summary

Introduction

Puberty marks the end of childhood and is a period when individuals undergo physiological and psychological changes to achieve sexual maturation and fertility [1]. Several studies have shown that the early onset of puberty may lead to a shorter adult height due to early skeletal maturation and early closure of the epiphyses [2], as well as increase the incidence of cardiovascular disease and diabetes [3, 4]. EP is a complex condition like PP, combining somatic symptoms with negative sequelae, including an increased risk of depression [5], behavioral disorders [6], distorted body perception[7], and hyperactivity/inattention in girls[8]. When PP results from premature maturation of the hypothalamic-pituitarygonadal axis, the condition is called central PP (CPP). Discrepancies between physical and chronological age in children with PP may reduce the adult height. Several studies have shown that GnRHa slows pubertal progression and bone maturation and improves adult stature [17, 18]

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