Suppression of Puberty in Girls with Short-Acting Intranasal versus Subcutaneous Depot GnRH Agonist

Abstract

Background/Aim: Central precocious puberty (CPP) is more common in females than in males. During the last few decades a new group of patients with CPP has been seen frequently in Northern Europe, namely children adopted from developing countries. GnRH analogue preparations, administered either as intranasal spray or as depot preparations, are the drugs of choice for inhibiting the release of gonadotropins. The aim of this study was to compare the effect of buserelin given by intranasal spray with that of the same compound given as a subcutaneous depot preparation. Methods: The study group comprised 46 pubertal girls below the age of 9.5 years, adopted from a developing country. During the first 2 years, the treatment used was buserelin acetate 300 µg 6 times daily as a nasal spray. During the third year the treatment was changed to Suprefact Depot, 6.3 mg, given as a subcutaneous implant every 8 weeks. Half of the girls were randomized to growth hormone treatment in addition to the pubertal inhibition. Results: GnRH provocation tests after 6 weeks, 1 year and 2 years of treatment with intranasal GnRH analogue showed suppression of gonadotropin secretion except in 1 case of noncompliance. During the third year, when the long-acting depot preparation was used, suppression was more pronounced. The peak LH response, especially, was considerably lower than during treatment with the nasal spray preparation. In all cases the clinical inhibition of puberty was adequate both during the first two years and during the third year. Conclusion: Even though the clinical suppression of puberty was adequate with both modes of administration, the effect of the depot preparation, in this study Suprefact Depot, was more pronounced in terms of gonadotropin suppression and less dependent on patient compliance.