Gonadotrophin-releasing hormone agonist treatment of central precocious puberty: an analysis of growth data in a developmental context.
Growth and skeletal maturation was assessed in 83 girls with central precocious puberty (CPP) during pituitary-gonadal suppression induced by treatment with a gonadotrophin-releasing hormone agonist (GnRHa). The mean pretreatment chronological age (CA) was 6.3 years and the mean bone age (BA) was 10.6 years. During the suppression of gonadal sex steroid secretion, mean height velocity (HV) decreased from a pretreatment value of 10.8 cm/year to 5.9 (year 1, n = 83), 4.9 (year 2, n = 72), 4.2 (year 3, n = 45), and 4.4 (year 4, n = 23) cm/year. During each interval, there was a negative correlation between HV and the pretreatment BA. In addition, the rate of skeletal maturation was reduced during GnRHa treatment (delta BA/delta CA = 0.6 +/- 0.1 over 3 years, n = 45). The rate of skeletal maturation during therapy was also negatively correlated with pretreatment BA. Predicted adult stature, based upon zeta-scores of height for BA, increased significantly and progressively during therapy but the changes in height SDS for BA varied significantly. Since HV, delta BA/delta CA, and the change in height SDS for BA (delta HT SDS for BA) during pituitary-gonadal suppression all correlated with the initial degree of skeletal maturation, the effect of GnRHa therapy on final adult height in children with CPP will be best understood if growth data are assessed within a developmental framework.
Boepple
P A
PA
Massachusetts General Hospital, Boston.
Mansfield
M J
MJ
Crawford
J D
JD
Crigler
J F
JF
Blizzard
R M
RM
Crowley
W F
WF
D000367:Age Factors; D001827:Body Height / Q000187:drug effects*; D001846:Bone Development / Q000187:drug effects*; D002648:Child; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000627:therapeutic use*; D006066:Gonads / Q000187:drug effects / Q000378:metabolism / Q000502:physiology; D006801:Humans; D007279:Injections, Subcutaneous; D011379:Prognosis; D011629:Puberty, Precocious / Q000175:diagnosis / Q000188:drug therapy*
D007987:Gonadotropin-Releasing Hormone