title: Central precocious puberty: revisiting the diagnosis and therapeutic management.
abstract: Clinical and laboratory diagnosis and treatment of central precocious puberty (CPP) remain challenging due to lack of standardization. The aim of this revision was to address the diagnostic and therapeutic features of CPP in Brazil based on relevant international literature and availability of the existing therapies in the country. The diagnosis of CPP is based mainly on clinical and biochemical parameters, and a period of follow-up is desirable to define the "progressive" form of sexual precocity. This occurs due to the broad spectrum of pubertal development, including isolated premature thelarche, constitutional growth and puberty acceleration, progressive and nonprogressive CPP, and early puberty. Measurement of basal and stimulated LH levels remains challenging, considering that the levels are not always in the pubertal range at baseline, short-acting GnRH is not readily available in Brazil, and the cutoff values differ according to the laboratory assay. When CPP is suspected but basal LH values are at prepubertal range, a stimulation test with short-acting or long-acting monthly GnRH is a diagnostic option. In Brazil, the treatment of choice for progressive CPP and early puberty is a long-acting GnRH analog (GnRHa) administered once a month or every 3 months. In Brazil, formulations of GnRHa (leuprorelin and triptorelin) are available and commonly administered, including 1-month depot leuprorelin 3.75 mg and 7.5 mg, 1-month depot triptorelin 3.75 mg, and 3-month depot leuprorelin 11.25 mg. Monthly or 3-month depot GnRHa are effective and safe to treat CPP. Arch Endocrinol Metab. 2016;60(2):163-72.
authors.affiliation: Departamento de Endocrinologia Pediátrica, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Vinícius Nahime
authors.initials: VN
authors.lastname: Brito
authors.affiliation: Departamento de Endocrinologia Pediátrica, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Angela Maria
authors.initials: AM
authors.lastname: Spinola-Castro
authors.affiliation: Departamento de Endocrinologia, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brasil.
authors.forename: Cristiane
authors.initials: C
authors.lastname: Kochi
authors.affiliation: Departamento de Endocrinologia, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brasil.
authors.forename: Cristiane
authors.initials: C
authors.lastname: Kopacek
authors.affiliation: Departamento de Endocrinologia Pediátrica, Sociedade Brasileira de Endocrinologia e Metabologia, Rio de Janeiro, RJ, Brasil.
authors.forename: Paulo César Alves da
authors.initials: PC
authors.lastname: Silva
authors.affiliation: Departamento de Endocrinologia, Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brasil.
authors.forename: Gil
authors.initials: G
authors.lastname: Guerra-Júnior
mesh_terms: D000367:Age Factors; D000886:Anthropometry; D001938:Brazil; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D011629:Puberty, Precocious / Q000175:diagnosis* / Q000188:drug therapy*; D012737:Sex Factors
chemical_list: D007987:Gonadotropin-Releasing Hormone; D007986:Luteinizing Hormone