Abstract
BackgroundIt is difficult to determine whether to treat a given girl who has idiopathic central precocious puberty (CPP) with gonadotropin-releasing hormone analog (GnRHa) in terms of adult height (AH). The objective was to provide an easy tool for predicting AH and age at first menstruation at initial evaluation to help guide the decision regarding whether to treat.MethodsData analysis using multiple linear regression models was performed in 134 girls with CPP. Among them 78 were given GnRHa because of low predicted AH (n=45), pubertal luteinising hormone (LH)/follicle-stimulating hormone peaks (FSH) ratio (n=50) and/or high plasma estradiol concentration (n=45). 56 girls were followed without treatment.ResultsIn the whole population, the actual AH (162.1±5.61 cm) was similar to target height (161.7±4.91 cm) and to AH predicted by the Bayley and Pinneau method (161.9±7.98 cm). Separated models for treated and untreated girls provide very close estimations, leading to a unique formula for both groups. The AH (cm) could be calculated at the initial evaluation: 2.21 (height at initial evaluation, SD) + 2.32 (target height, SD) – 1.83 (LH/FSH peaks ratio) + 159.68. The actual AH was lower than the calculated AH by more than 1 SD (5.6 cm) in 11 girls (8.0%). The time between onset of puberty and first menstruation (in untreated girls) can be estimated with: 10.9 - 0.57 (LH/FSH peaks ratio). The formulae are available at http://www.kamick.org/lemaire/med/girls-cpp15.html.ConclusionsWe established formulae that can be used at an initial evaluation to predict the AH, and the time between onset of puberty and first menstruation after spontaneous puberty. The similarity of the formulae for both groups suggests that the treatment had no significant effect on the AH. However, the criteria used to select treatment suggest that it prevents the deterioration of AH in cases with rapidly evolving form of CPP.
Highlights
Central precocious puberty (CPP) in girls is defined as the development of sexual characteristics before the age of 8 years due to the premature activation of the hypothalamo-pituitaryovarian axis [1]
The actual adult height (AH) (162.1±5.61 cm) was similar to target height (161.7 ±4.91 cm) and to AH predicted by the Bayley and Pinneau method (161.9±7.98 cm)
We established formulae that can be used at an initial evaluation to predict the AH, and the time between onset of puberty and first menstruation after spontaneous puberty
Summary
Central precocious puberty (CPP) in girls is defined as the development of sexual characteristics before the age of 8 years due to the premature activation of the hypothalamo-pituitaryovarian axis [1]. Treatment with gonadotropin-releasing hormone (GnRH) analog (GnRHa) blocks the pituitary-ovarian axis and the secretion of estradiol, thereby slowing bone age (BA) progression and preserving growth potential [2]. The effect of this treatment on AH fluctuates, primarily because the progression of idiopathic CPP varies between unsustained forms, called slowly progressing forms [3], and rapidly progressing forms [4]. Because of this variability, randomized prospective trials are not appropriate means for deciding treatment. It is difficult to determine whether to treat a given girl who has idiopathic central precocious puberty (CPP) with gonadotropin-releasing hormone analog (GnRHa) in terms of adult height (AH). Academic Editor: Andrew Wolfe, John Hopkins University School of Medicine, UNITED STATES
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