Treatment of central precocious puberty

Abstract

In consideration of the large number of the rapid advances in this area, it seems appropriate to highlight some of the recent studies that address factors involved in the decision to treat a child with central precocious puberty, and two recent advances in drug therapy. There are still many areas of uncertainty regarding treatment of central precocious puberty, including the hormonal test results that support the diagnosis, the best way to predict adult height, and the effect of the age of the child on the amount of height gained during treatment (adult height minus predicted height). Many studies show that children with onset of symptoms before age 6 benefit the most, but a recent study showed no difference in height benefit between girls initially seen at at least 7 or more than 7 years. Two reports indicate that greater delay from the onset of puberty to the start of therapy with gonadotropin-releasing hormone analogue has a negative effect on adult height. Although there has been considerable experience with monthly injections of gonadotropin-releasing hormone analogues to suppress pubertal development, recent studies show that a slower released formulation given every 3 months is also effective in the majority of patients. The newest form of therapy involves a subcutaneous implant of the gonadotropin-releasing hormone analogue histrelin, which gives excellent gonadotropin suppression for 12 months. Treatment of central precocious puberty continues to be a very active area of clinical investigation, but there are still unresolved questions that future studies will need to address.