Comparison of the Clinical and Anthropometric Features of Treated and Untreated Girls with Borderline Early Puberty

Demirkale, Zeynep Hızlı; Abalı, Zehra Yavaş; Baş, Firdevs; Poyrazoğlu, Şükran; Bundak, Rüveyde; Darendelıler, Feyza

doi:10.1016/j.jpag.2019.01.003

Cited by 6 publications

(3 citation statements)

References 31 publications

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“…In the report of Demirkale et al , treatment with GnRHa compensated the decreased PAH and normalized it, although the final height was not different with untreated girls. [12] This finding is in part in line with our study in EP girls treated with GnRHa. Some reports demonstrated that GnRHa treatment does not affect the final height in borderline EP or physiological normal puberty with rapid progress[1314] which is in favor of our result.…”

Section: Discussionsupporting

confidence: 90%

The Effects of gonadotropin-releasing hormone analog and a combination of gonadotropin-releasing hormone analog and recombinant human growth hormone on adult height in girls with early puberty

et al. 2019

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Background:Early puberty (EP) is due to the activation of gonadotropin-releasing hormone (GnRH) pulse generator in lower ages; EP may be a potential cause for impairment of adult height, leading to short stature. The aim of this study was to determine the effects of GnRH analog (GnRHa) and GnRHa plus recombinant human growth hormone (rhGH) treatment on final height in healthy girls with EP.Materials and Methods:Fifty EP girls (sexual maturity rating: 2–3) with chronological age (CA) 9.22 ± 0.56 and bone age (BA) 9.74 ± 0.59 years were treated with GnRHa (Triptorelin) at a dose of 100 μg/kg body weight (BW) as intramuscular every 28 days for 2.82 ± 0.57 years; 45 EP girls with CA 9.84 ± 0.57 and BA 10.14 ± 1.02 years were also treated with the same GnRHa plus rhGH (Norditropin) at a dose of 0.1 unit/kg BW daily for 6 days in a week for 2.55 ± 0.6 years. In the control group, 33 EP girls followed for the same period without treatment. Height, weight, and body mass index of girls and parents were assessed. Predicted adult height (PAH) at the start and the end of the study and target height were assessed.Results:PAH at the end of the study in the GnRHa group was not different with untreated girls. PAH at the end of the treatment in GnRHa plus rhGH group was significantly higher than both untreated and GnRHa group. PAH at the end of therapy in GnRHa plus rhGH group was significantly more than their target height.Conclusion:GnRHa therapy has a benefit effect in achievement of target height. Combination therapy with GnRHa plus rhGH increased their PAH more than both untreated and GnRHa groups.

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Section: Discussionsupporting

confidence: 90%

The Effects of gonadotropin-releasing hormone analog and a combination of gonadotropin-releasing hormone analog and recombinant human growth hormone on adult height in girls with early puberty

et al. 2019

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“…An American longitudinal study of 380 girls, followed between birth and a mean age of 15.5 years, indicated a comparable FAH between girls with EP and those with late onset puberty ( 29 ). A meta-analysis conducted by Cheng et al ( 38 ) also demonstrated that girls with EP have a greater potential for growth than girls with late-onset puberty ( 39 – 41 ). As shown in our study, girls with EP who had reached their FAH were, on average, 3.0 cm taller than their predicted MPH.…”

Section: Discussionmentioning

confidence: 97%

Pattern of linear growth and progression of bone maturation for girls with early-onset puberty: A mixed longitudinal study

Liu

Su²,

Pan³

et al. 2023

Front. Pediatr.

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Background and objectiveWith a worldwide trend to earlier age of onset of puberty, the prevalence of early-onset puberty (EP) among girls has increased. The impact of EP on the pattern of linear growth and bone maturation is unclear. Accordingly, the objective of our study was to describe this pattern for girls with EP in Shenzhen, China.MethodsA total of 498 untreated girls diagnosed with EP at Shenzhen Children's Hospital, China, between January 2016 and December 2021. A total of 1,307 anthropometric measurements and 1,307 left-hand radiographs were available for analysis. Artificial intelligence (AI) was used to determine bone age (BA). Participants were classified into groups according to chronological age (CA) and BA. The pattern of linear growth (height) and progression of bone maturation was described between groups using the Lambda-Mu-Sigma (LMS) method. Published height-for-CA and height-for-BA norm references for a healthy Chinese population were used for age-appropriate comparisons.ResultsThe mean CA of appearance of first pubertal signs (breast buds) was 8.1 ± 0.5 years. Compared to norm-referenced data, girls with EP were significantly taller at a CA of 7–10 years. This was followed by a slowing in linear growth after a CA of 10 years, with 71 girls with EP having already achieved their target adult height. From 7 to 10 years of BA, the linear growth was slower in the EP group compared to norm-reference values. This was followed by a period of catch-up growth at 11.2 years of BA, with growth curves approaching norm-referenced values. The BA progressed rapidly from 7 to 8 years of age in about half of the girls with EP (median ΔBA/ΔCA >1.9), slowing, thereafter, until the period of catch-up growth at 11.2 years of BA.ConclusionsBA provides a more reliable reference than CA to assess growth parameters among girls with EP. Our limited data set does indicate that EP does not negatively impact final adult height. Therefore, the growth curves from our study are relevant, providing a reference for pediatricians in this clinical population and, thus, preventing over-treatment for EP.

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“…Girls with advanced progressive puberty starting between 8 and 9 years of age ( 26 ) and advanced-normal puberty with onset between 8.5 and 10 years ( 27 ) with an initial height prediction 3–5 cm lower than their TH (practically up to −1 SD) have been found to have no benefit in final height from pubertal inhibition, practically reaching their TH even without treatment, showing that gonadotropin-suppressive therapy in the above groups affects the pace of puberty but not the total pubertal growth or final height. However, in selected girls with rapidly progressive borderline early puberty starting between 7 and 10 years, treatment with GnRHa may be considered ( 28 ). If untreated, these girls were found to lose 3.6 cm compared to normal controls, which was exactly the real gain found in group B in the GAIL study, i.e., in the girls treated with leuprorelin alone.…”

Section: Discussionmentioning

confidence: 99%

Anastrozole monotherapy further improves near-adult height after the initial combined treatment with leuprorelin and anastrozole in early-maturing girls with compromised growth prediction: results from the second phase of the GAIL study

Papadimitriou,

Dermitzaki,

Christopoulos

et al. 2024

Front. Endocrinol.

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BackgroundThe first phase of the GAIL study (“Girls treated with an Aromatase Inhibitor and Leuprorelin,” ISRCTN11469487) has shown that the combination of anastrozole and leuprorelin for 24 months is safe and effective in improving the predicted adult height (PAH) in girls with early puberty and compromised growth prediction by +1.21 standard deviation score (SDS; +7.51 cm) compared to inhibition of puberty alone, +0.31 SDS (+1.92 cm).Objectives and hypothesesIn the second phase of the GAIL study, we assessed the adult height (AH)/near-adult height (NAH) at the end of the first phase and, in addition, the efficacy of anastrozole monotherapy thereafter in further improving NAH.MethodsWe measured the AH (age 16.5 years)/NAH [bone age (BA), 15 years] of the 40 girls included, divided into two matched groups: group A (20 girls on anastrozole + leuprorelin) and group B (20 girls on leuprorelin alone). Group A was further randomized into two subgroups: A1 and A2. Group A1 (n = 10), after completion of the combined therapy, received anastrozole 1 mg/day as monotherapy until BA 14 years, with a 6-month follow-up. Group A2 (n = 10) and group B (n = 20), who received only the combined treatment and leuprorelin alone, respectively, were recalled for evaluation of AH/NAH.ResultsAH or NAH exceeded the PAH at the completion of the 2-year initial phase of the GAIL study in all groups, but the results were statistically significant only in group A1: NAH–PAH group A1, +3.85 cm (+0.62 SDS, p = 0.01); group A2, +1.6 cm (+0.26 SDS, p = 0.26); and group B, +1.7 cm (+0.3 SDS, p = 0.08). The gain in group A1 was significantly greater than that in group A2 (p = 0.04) and in group B (p = 0.03). Anastrozole was determined to be safe even as monotherapy in Group A1.ConclusionsIn early-maturing girls with compromised growth potential, the combined treatment with leuprorelin and anastrozole for 2 years or until the age of 11 years resulted in a total gain in height of +9.7 cm when continuing anastrozole monotherapy until the attainment of NAH, as opposed to +7.4 cm if they do not continue with the anastrozole monotherapy and +3.6 cm when treated with leuprorelin alone. Thus, the combined intervention ends at the shortest distance from the target height if continued with anastrozole monotherapy until BA 14 years.

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Comparison of the Clinical and Anthropometric Features of Treated and Untreated Girls with Borderline Early Puberty

Cited by 6 publications

References 31 publications

The Effects of gonadotropin-releasing hormone analog and a combination of gonadotropin-releasing hormone analog and recombinant human growth hormone on adult height in girls with early puberty

The Effects of gonadotropin-releasing hormone analog and a combination of gonadotropin-releasing hormone analog and recombinant human growth hormone on adult height in girls with early puberty

Pattern of linear growth and progression of bone maturation for girls with early-onset puberty: A mixed longitudinal study

Anastrozole monotherapy further improves near-adult height after the initial combined treatment with leuprorelin and anastrozole in early-maturing girls with compromised growth prediction: results from the second phase of the GAIL study

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