Effect of central precocious puberty and gonadotropin-releasing hormone analogue treatment on peak bone mass and final height in females

Bertelloni, Silvano; Baroncelli, Gi; Sorrentino, M. C.; Perri, G; Saggese, Giuseppe

doi:10.1007/s004310050831

Cited by 102 publications

(61 citation statements)

References 27 publications

(47 reference statements)

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“…The mean FH of our patients compared favorably (4,5,11,12) or unfavorably (13-16) with the one reported by other authors in CTPP girls treated with GnRH agonists.…”

Section: Discussionsupporting

confidence: 71%

Analysis of the factors affecting auxological response to GnRH agonist treatment and final height outcome in girls with idiopathic central precocious puberty

Arrigo

Cisternino

Galluzzi

et al. 1999

European Journal of Endocrinology

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The aim of this retrospective study was to analyze the factors which affected the auxological response to GnRH agonist treatment and the final height (FH) outcome in 71 girls with idiopathic and truly precocious (onset before 8 years) central puberty (CTPP) who had been treated with the same therapy protocol (Decapeptyl Depot, 60 mg/kg i.m. every 28 days) for at least 2 years (since 7.0 Ϯ 1.3 (S.D.) years of age) and followed until puberty was completed and FH was reached.During the entire treatment period we observed: (a) a decrease of height standard deviation scores (SDS) (from 1.5 Ϯ 1.7 to 0.9 Ϯ 1.3 SDS, P < 0.01); (b) a striking deceleration of bone age (BA), revealed by the subnormal DBA:Dchronological age (CA) ratio (0.2 Ϯ 0.1); (c) an increase of predicted adult height (from 155.6 Ϯ 7.0 to 160.7 Ϯ 6.7 cm, P < 0.0005). Treatment interruption was followed by an important catch-down growth, with an FH (158.4 Ϯ 5.8 cm) lower (P < 0.025) than that predicted at the end of therapy. However, FH fell within the population norm and the target range in respectively 87.3 and 90% of the patients. The tallest FH was recorded in the patients who started therapy at less than 6 years of age and in those who discontinued treatment at a BA of 12.0-12.5 years. At stepwise regression analysis, FH in the whole study population was positively affected by the following independent factors: (a) height at the end of therapy (F = 45.45, P < 0.0001); (b) pretreatment height (F = 13.91, P < 0.0005); (c) treatment duration (F = 8.51, P < 0.005); (d) target height (TH) (F = 7.70, P < 0.01).We conclude that: (i) most girls with idiopathic CTPP treated by GnRH agonists may achieve an adult height within the population norm and/or their target range; (ii) the height gain from therapy onset until FH attainment, however, is generally rather limited (on average 2.9 cm) and only few patients are able to reach their target percentile; (iii) the most favorable height prognosis with respect to TH is generally observed in the subjects with the tallest height at the end of treatment and the lowest BA2:CA2 ratio, due to the important deterioration of height prognosis which frequently follows therapy interruption; (iv) FH is also significantly conditioned by both TH and treatment duration; (v) in order to strengthen the weak therapeutic effect of GnRH agonists in CTPP this treatment should be started as early as possible and discontinued at a BA of 12.0-12.5 years.

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“…The mean FH of our patients compared favorably (4,5,11,12) or unfavorably (13-16) with the one reported by other authors in CTPP girls treated with GnRH agonists.…”

Section: Discussionsupporting

confidence: 71%

Analysis of the factors affecting auxological response to GnRH agonist treatment and final height outcome in girls with idiopathic central precocious puberty

Arrigo

Cisternino

Galluzzi

et al. 1999

European Journal of Endocrinology

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“…The great majority of patients reached an adult height consistent with the TH (13,14,15,17,18,19,20,21,22,23,24,25), a minority of them did not reach the TH (19,26), and a very small portion of patients remained shorter than the predicted height before treatment (13,27). Discordant results were obtained when comparing the efficacy of treatment in females and males.…”

Section: Adult Heightmentioning

confidence: 81%

“…The efficacy of the various GnRHa in terms of HG appeared similar (24,27,31), except for a study (32) showing a higher adult height SDS in patients treated with leuprolide depot compared to triptorelin depot.…”

Section: Adult Heightmentioning

confidence: 86%

“…Heger et al (22) described normal BMD for age in women after GnRHa treatment, with a 17% prevalence of osteopenia. In a small group of CPP-treated female adolescents, Bertelloni et al (27) showed patients' BMD was not different from that of their mothers. In male patients, evaluated at adult height, BMD was similar to that found in a group of healthy young Italian men with normal pubertal development (55).…”

Section: Bone Mineral Densitymentioning

confidence: 96%

“…In general, HG was highly variable among studies depending on sample characteristics including the progression of pubertal development. Pubertal development was specified as rapidly progressing in some studies (17,22,24,27,28,29), whereas in others pubertal progression was not detailed.…”

Section: Adult Heightmentioning

confidence: 99%

See 2 more Smart Citations

MANAGEMENT OF ENDOCRINE DISEASE: Long-term outcomes of the treatment of central precocious puberty

Guaraldi

Beccuti

Gori

et al. 2016

European Journal of Endocrinology

118

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GnRH analogues (GnRHa) are the treatment of choice for central precocious puberty (CPP), with the main objective to recover the height potential compromised by the premature fusion of growth cartilages. The aim of this review was to analyze longterm effects of GnRHa on height, body weight, reproductive function, and bone mineral density (BMD) in patients with CPP, as well as the potential predictors of outcome. Because randomized controlled trials on the effectiveness and long-term outcomes of treatment are not available, only qualified conclusions about the efficacy of interventions can be drawn. GnRHa treatment appears to improve adult height in girls with CPP, especially if diagnosed before the age of 6, whereas a real benefit in terms of adult height is still controversial in patients with the onset of puberty between 6 and 8 years of age. No height benefit was shown in patients treated after 8 years. Gonadal function is promptly restored in girls after cessation of treatment, and reproductive potential appears normal in young adulthood. Data are conflicting on the long-term risk of polycystic ovarian syndrome in both treated and untreated women. Fat mass is increased at the start of treatment but normalizes thereafter, and GnRHa itself does not seem to have any long-term effect on BMI. Similarly, analogue treatment does not appear to have a negative impact on BMD. Owing to the paucity of data available, no conclusions can be drawn on the repercussions of CPP and/or its treatment on the timing of menopause and on the health of the offspring.

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Management of Disordered Puberty

Mieszczak

Houk

Lee

2009

Brook's Clinical Pediatric Endocrinology

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Effect of central precocious puberty and gonadotropin-releasing hormone analogue treatment on peak bone mass and final height in females

Cited by 102 publications

References 27 publications

Analysis of the factors affecting auxological response to GnRH agonist treatment and final height outcome in girls with idiopathic central precocious puberty

Analysis of the factors affecting auxological response to GnRH agonist treatment and final height outcome in girls with idiopathic central precocious puberty

MANAGEMENT OF ENDOCRINE DISEASE: Long-term outcomes of the treatment of central precocious puberty

Management of Disordered Puberty

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