Treatment of familial male precocious puberty with spironolactone, testolactone, and deslorelin.
Combined antiandrogen (spironolactone) and aromatase inhibitor (testolactone) are effective for the short term treatment of familial male precocious puberty. During this therapy, plasma testosterone levels remain in the adult range, since spironolactone blocks the testosterone receptor without significantly affecting plasma testosterone levels. After our initial 18-month pilot study, we continued to treat eight boys with the combined therapy for 2.0-4.2 yr. During this time all boys exhibited a pubertal rise in gonadotropin secretion and a diminishing response to treatment, which was manifested by the recurrence of clinical features of puberty and an increase in the bone maturation rate (P < 0.05). Addition of the LHRH agonist deslorelin (4 micrograms/kg.day, sc) to the combined therapy decreased peak LH, plasma testosterone, bone maturation rate, and growth velocity (P < 0.05) over the next year. We conclude that the rise in gonadotropin levels during central activation of hypothalamic LHRH secretion in boys with familial male precocious puberty causes a partial escape from the combined effect of spironolactone and testolactone. The addition of deslorelin to the combined therapy appears to restore the control of puberty in this setting.
Laue
L
L
Development Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892.
Jones
J
J
Barnes
K M
KM
Cutler
G B
GB
D000365:Age Determination by Skeleton; D001827:Body Height; D001846:Bone Development / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005640:Follicle Stimulating Hormone / Q000097:blood; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006128:Growth / Q000187:drug effects; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D010865:Pilot Projects; D011629:Puberty, Precocious / Q000097:blood / Q000188:drug therapy* / Q000235:genetics; D013148:Spironolactone / Q000627:therapeutic use*; D013738:Testolactone / Q000627:therapeutic use*; D013739:Testosterone / Q000097:blood; D017329:Triptorelin Pamoate / Q000031:analogs & derivatives
D017329:Triptorelin Pamoate; D013148:Spironolactone; D007987:Gonadotropin-Releasing Hormone; D013739:Testosterone; D013738:Testolactone; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; C066438:deslorelin