Ann Pediatr Endocrinol Metab.  2013 Mar;18(1):19-25. 10.6065/apem.2013.18.1.19.

Different clinical courses of central precocious girls according to their age at presentation and treatment

• Yoon SA
• Han HS
• Kim H
• Yun SC

• KMID: 1429675
• DOI: http://doi.org/10.6065/apem.2013.18.1.19

Abstract

PURPOSE
The progressivity of central precocious puberty (CPP) seems to depend on the age at presentation. We evaluated the clinical courses of CPP girls according to their age at initiation of treatment.
METHODS
One hundred thirty five girls with CPP diagnosed between Jan. 2003 and Dec. 2009 and regularly followed for more than one year were included. They were treated with gonadotropin-releasing hormone agonists (GnRHa) every four weeks. Subjects were divided into two groups based on whether they were treated before (Group I, N=20) or after seven years of age (Group II, N=115). We compared the anthropometric parameters, the predicted adult height (PAH), predicted treatment periods, and the laboratory findings of the two groups every six months.
RESULTS
Out of 135 CPP patients, 123 were idiopathic and twelve had neurogenic problems. At the baseline, patients' average bone age (BA) was significantly older than chronologic age (CA) and PAH was significantly shorter than target height (TH). BA and CA were significantly older in group II, but the BA/CA ratio was significantly greater in group I. The average treatment period required to overcome the CA-BA difference was 4.64 yr (group I vs II; 7.98 yr vs 4.24 yr, P < 0.01), and the period needed to overcome PAH-TH difference was 2.49 yr (group I vs II; 4.37 yr vs 2.32 yr, P < 0.01).
CONCLUSION
Among the girls with CPP, the younger age group had more advanced BA than CA, and needed significantly longer treatment periods to overcome the BA-CA gap and PAH-TH gaps.

Keyword

Precocious puberty; Gonadotropin-releasing hormone

MeSH Terms

Adult
Gonadotropin-Releasing Hormone
Humans
Piperazines
Puberty, Precocious
Gonadotropin-Releasing Hormone
Piperazines

Figure

• 

  Fig. 1 (A) The difference between BA (filled circle) and CA (open circle) was estimated to disappear at an average of 4.64 years of gonadotropin-releasing hormone agonist treatment. (B) The PAH (filled rectangle)-TH (dashed line) difference was estimated to disappear at an average of 2.49 years of treatment with increasing HT (open rectangle). (C) In addition, the PAHSDS (filled diamond)-HSDS (dashed line) difference became equal at 2.48 years of treatment, and the BA/CA ratio (filled triangle) approached to 1 in the 3rd and 4th years of treatment. BA, bone age; CA, chronologic age; PAH, predicted adult height; TH, target height; HT, height; PAHSDS, predicted adult height standard deviation score; HSDS, height standard deviation score; THSDS, target height standard deviation score; FU, follow-up.

• 

  Fig. 2 The estimated disappearing period for the BA (filled circle)-CA (open circle) gap in group I (A: average, 7.98 years; 95% confidence interval [CI], 3.88 to 12.07) was significantly different (P <0.01) from group II (B: average, 4.24 years; 95% CI, 3.74 to 4.73). BA, bone age; CA, chronologic age; FU, follow-up.

• 

  Fig. 3 The estimated disappearing period for the PAH (filled rectangle)-TH (dashed line) difference in group I (A: average, 4.37 years; 95% confidence interval [CI], 0 to 12.58) was significantly different (P <0.01) from group II (B: average, 2.32 years; 95% CI, 1.48 to 3.16) with increasing HT (open rectangle). PAH, predicted adult height; TH, target height; HT, height; FU, follow-up.

• 

  Fig. 4 The estimated disappearing period for the PAHSDS (filled diamond)-THSDS (dashed line) difference in group I (A: average, 4.37 years; 95% confidence interval [CI], 0 to 12.58) was significantly different (P <0.01) from group II (B: average, 2.31 years; 95% CI, 1.48 to 3.14) with a BA/CA ratio (filled triangle) approaching 1. PAHSDS, predicted adult height standard deviation score; THSDS, target height standard deviation score; BA/CA, bone age/chronologic age; FU, follow-up.

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