Gonadotropin-releasing Hormone Analogue and Recombinant Human Growth Hormone Treatment for Idiopathic Central Precocious Puberty in Girls

Overview

Journal Front Endocrinol (Lausanne)

Specialty Endocrinology

Date 2023 Jan 2

PMID 36589818

Authors

Yuzhen Shi

Ziyi Ma

Xi Yang

Yanqin Ying

Xiaoping Luo

Ling Hou

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the effectiveness and safety of gonadotropin-releasing hormone analogue (GnRHa) in combination with recombinant human growth hormone (rhGH) in girls with central precocious puberty (CPP).

Methods: Clinical data of 80 girls diagnosed with idiopathic central precocious puberty (ICPP) between January 2017 and June 2021 were retrospectively analyzed. Treatment strategy involved GnRHa alone (group A: n=34) and GnRHa+rhGH (group B: n=46). Children's heights (Ht), weights (Wt) and sex hormone levels were measured every 3 months after treatment and bone age (BA) every six months. Heights, growth velocity (GV), predicted adult height (PAH), weights, body mass index (BMI), sex hormone levels and bone age were compared between the two groups.

Results: Children in group B showed greater height gain at the 12th, 24th and 30th months after treatment (p<0.05) than those in group A, had faster growth rates in the first and second year following treatment (p<0.05) and better PAH (p<0.05). No statistical differences in weight or BMI were found between the two groups before treatment or at any time after treatment (p>0.05). Levels of LH and FSH were lower in both groups after treatment with no statistical differences between groups (p>0.05). The gap between bone age and chronological age gradually decreased in both groups and no abnormal progression of bone age or other adverse side effects occurred.

Conclusions: The combination of GnRHa with rhGH produced better height gains than GnRHa alone for patients with CPP. The gonadal axis was suppressed and progression of bone age delayed with good safety and efficacy.

Citing Articles

[Considerations on the improvement of height benefit in children with central precocious puberty].

Liang L Zhongguo Dang Dai Er Ke Za Zhi. 2024; 26(1):19-24.

PMID: 38269454 PMC: 10817732. DOI: 10.7499/j.issn.1008-8830.2308078.

References

Wang M, Zhang Y, Lan D, Hill J . The Efficacy of GnRHa Alone or in Combination with rhGH for the Treatment of Chinese Children with Central Precocious Puberty. Sci Rep. 2016; 6:24259. PMC: 4829831. DOI: 10.1038/srep24259. View

Mansfield M, Rudlin C, CRIGLER Jr J, Karol K, Crawford J, Boepple P . Changes in growth and serum growth hormone and plasma somatomedin-C levels during suppression of gonadal sex steroid secretion in girls with central precocious puberty. J Clin Endocrinol Metab. 1988; 66(1):3-9. DOI: 10.1210/jcem-66-1-3. View

Weise M, Barnes K, Gafni R, Abad V, Baron J . Effects of estrogen on growth plate senescence and epiphyseal fusion. Proc Natl Acad Sci U S A. 2001; 98(12):6871-6. PMC: 34445. DOI: 10.1073/pnas.121180498. View

Cheuiche A, da Silveira L, de Paula L, Lucena I, Silveiro S . Diagnosis and management of precocious sexual maturation: an updated review. Eur J Pediatr. 2021; 180(10):3073-3087. DOI: 10.1007/s00431-021-04022-1. View

Cara J, Kreiter M, Rosenfield R . Height prognosis of children with true precocious puberty and growth hormone deficiency: effect of combination therapy with gonadotropin releasing hormone agonist and growth hormone. J Pediatr. 1992; 120(5):709-15. DOI: 10.1016/s0022-3476(05)80232-x. View

Cisternino M, Draghi M, Lauriola S, Scarcella D, Bernasconi S, Cavallo L . The acid-labile subunit of human ternary insulin-like growth factor-binding protein complex in girls with central precocious puberty before and during gonadotropin-releasing hormone analog therapy. J Clin Endocrinol Metab. 2002; 87(10):4629-33. DOI: 10.1210/jc.2002-020308. View

Attie K, Ramirez N, Conte F, Kaplan S, Grumbach M . The pubertal growth spurt in eight patients with true precocious puberty and growth hormone deficiency: evidence for a direct role of sex steroids. J Clin Endocrinol Metab. 1990; 71(4):975-83. DOI: 10.1210/jcem-71-4-975. View

Weise M, Flor A, Barnes K, Cutler Jr G, Baron J . Determinants of growth during gonadotropin-releasing hormone analog therapy for precocious puberty. J Clin Endocrinol Metab. 2004; 89(1):103-7. DOI: 10.1210/jc.2002-021999. View

Klein K, Barnes K, Jones J, Feuillan P, Cutler Jr G . Increased final height in precocious puberty after long-term treatment with LHRH agonists: the National Institutes of Health experience. J Clin Endocrinol Metab. 2001; 86(10):4711-6. DOI: 10.1210/jcem.86.10.7915. View

10.

Choi K, Park S . An increasing tendency of precocious puberty among Korean children from the perspective of COVID-19 pandemic effect. Front Pediatr. 2022; 10:968511. PMC: 9454605. DOI: 10.3389/fped.2022.968511. View

11.

Eckert-Lind C, Busch A, Petersen J, Biro F, Butler G, Brauner E . Worldwide Secular Trends in Age at Pubertal Onset Assessed by Breast Development Among Girls: A Systematic Review and Meta-analysis. JAMA Pediatr. 2020; 174(4):e195881. PMC: 7042934. DOI: 10.1001/jamapediatrics.2019.5881. View

12.

Vottero A, Pedori S, Verna M, Pagano B, Cappa M, Loche S . Final height in girls with central idiopathic precocious puberty treated with gonadotropin-releasing hormone analog and oxandrolone. J Clin Endocrinol Metab. 2006; 91(4):1284-7. DOI: 10.1210/jc.2005-1693. View

13.

Lopez-Miralles M, Lacomba-Trejo L, Valero-Moreno S, Benavides G, Perez-Marin M . Psychological aspects of pre-adolescents or adolescents with precocious puberty: A systematic review. J Pediatr Nurs. 2022; 64:e61-e68. DOI: 10.1016/j.pedn.2022.01.002. View

14.

Oostdijk W, Drop S, Odink R, Hummelink R, Partsch C, Sippell W . Long-term results with a slow-release gonadotrophin-releasing hormone agonist in central precocious puberty. Dutch-German Precocious Puberty Study Group. Acta Paediatr Scand Suppl. 1991; 372:39-45; discussion 46. DOI: 10.1111/j.1651-2227.1991.tb17967.x. View

15.

Lazar L, Padoa A, Phillip M . Growth pattern and final height after cessation of gonadotropin-suppressive therapy in girls with central sexual precocity. J Clin Endocrinol Metab. 2007; 92(9):3483-9. DOI: 10.1210/jc.2007-0321. View

16.

Kim M, Koh H, Lee G, Kang D, Kim S . Comparing adult height gain and menarcheal age between girls with central precocious puberty treated with gonadotropin-releasing hormone agonist alone and those treated with combined growth hormone therapy. Ann Pediatr Endocrinol Metab. 2019; 24(2):116-123. PMC: 6603606. DOI: 10.6065/apem.2019.24.2.116. View

17.

Gyon Y, Yun Y, Kim Y, Han H . Age at menarche and near final height after treatment with gonadotropin-releasing hormone agonist alone or combined with growth hormone in Korean girls with central precocious puberty. Clin Pediatr Endocrinol. 2015; 24(4):175-83. PMC: 4628952. DOI: 10.1297/cpe.24.175. View

18.

Sklar C, Rothenberg S, Blumberg D, Oberfield S, LEVINE L, David R . Suppression of the pituitary-gonadal axis in children with central precocious puberty: effects on growth, growth hormone, insulin-like growth factor-I, and prolactin secretion. J Clin Endocrinol Metab. 1991; 73(4):734-8. DOI: 10.1210/jcem-73-4-734. View

19.

Fu J, Zhang J, Chen R, Ma X, Wang C, Chen L . Long-Term Outcomes of Treatments for Central Precocious Puberty or Early and Fast Puberty in Chinese Girls. J Clin Endocrinol Metab. 2019; 105(3). DOI: 10.1210/clinem/dgz027. View

20.

Wit J . Should Skeletal Maturation Be Manipulated for Extra Height Gain?. Front Endocrinol (Lausanne). 2022; 12:812196. PMC: 8716689. DOI: 10.3389/fendo.2021.812196. View