Endocrinol Metab.  2010 Sep;25(3):206-212. 10.3803/EnM.2010.25.3.206.

The Comparison of Clinical Factors according to Growth Velocity during Gonadotropin-Releasing Hormone Agonist Treatment in Central Precocious Puberty Girls

• Nam HK
• Shin JY
• Oh YJ
• Rhie YJ
• Yoo Y
• Park SH
• Lee KH

• KMID: 2169058
• DOI: http://doi.org/10.3803/EnM.2010.25.3.206

Abstract

BACKGROUND
The aim of this study was to investigate the favorable factors for gonadotropin-releasing hormone (GnRH) agonist treatment with regard to the growth velocity and the predicted adult height (PAH) in central precocious puberty (CPP) girls.
METHODS
We reviewed the clinical and auxological parameters in 46 CPP girls who were treated with GnRH agonist at the pediatric endocrinology clinic of Korea University Hospital from January 2001 to August 2007. We divided the two groups according to the growth velocity of 5 cm/yr and we assessed the related factors associated with growth velocity. We also assessed the changes in PAH for two years.
RESULTS
The pretreatment chronological age and bone age were significantly younger in the high growth velocity group (> 5 cm/yr) compared to that of the low growth velocity group (7.8 +/- 0.9 year vs. 8.4 +/- 0.5 year, 9.4 +/- 1.2 year vs. 10.1 +/- 0.9 year, respectively) (P < 0.05). The PAH after treatment was significantly greater in the high growth velocity group (> 5 cm/yr)(P < 0.05). Growth velocity during treatment had negative correlation with the pretreatment chronological age and positive correlation with the PAH after one and two years of treatment (r = -0.45, P < 0.05 and r = 0.51, P < 0.01). PAH had positive correlation with the treatment duration (r = 0.31, P < 0.05).
CONCLUSION
In our study, the growth velocity during GnRH agonist treatment was negatively related to age at the initiation of treatment. Therefore, earlier treatment is important to improve the outcomes and to maintain appropriate growth velocity in CPP girls.

Keyword

Gonadotropin releasing hormone agonist; Growth velocity; Precocious puberty; Predicted adult height

MeSH Terms

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

Figure

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  Fig. 1 Relationship between growth velocity and chronological age before treatment.

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  Fig. 2 Relationship between growth velocity and predicted adult height after two year treatment.

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  Fig. 3 Comparisons of between target adult height and predicted adult height during two year treatment. PAH, predicted adult height; TAH, target adult height.

Reference

1. Papadimitriou A, Beri D, Tsialla A, Fretzayas A, Psychou F, Nicolaidou P. Early growth acceleration in girls with idiopathic precocious puberty. J Pediatr. 2006. 149:43–46.

2. Yoo SY, Yoo HW. Effects of treatment with long-acting gonadotropin-releasing hormone agonist on somatic growth in patients with central precocious puberty. J Korean Soc Pediatr Endocrinol. 1998. 3:59–67.

3. Traggiai C, Stanhope R. Disorders of pubertal development. Best Pract Res Clin Obstet Gynaecol. 2003. 17:41–56.

4. Kakarla N, Bradshaw KD. Disorders of pubertal development: precocious puberty. Semin Reprod Med. 2003. 21:339–351.

5. Mrug S, Elliott M, Gilliland MJ, Grunbaum JA, Tortolero SR, Cuccaro P, Schuster M. Positive parenting and early puberty in girls: protective effects against aggressive behavior. Arch Pediatr Adolesc Med. 2008. 162:781–786.

6. Mul D, de Muinck Keizer-Schrama SM, Oostdijk W, Drop SL. Auxological and biochemical evaluation of pubertal suppression with the GnRH agonist leuprolide acetate in early and precocious puberty. Horm Res. 1999. 51:270–276.

7. Mansfield MJ, Beardsworth DE, Loughlin JS, Crawford JD, Bode HH, Rivier J, Vale W, Kushner DC, Crigler JF Jr, Crowley WF Jr. Long-term treatment of central precocious puberty with a long-acting analogue of luteinizing hormone-releasing hormone. Effects on somatic growth and skeletal maturation. N Engl J Med. 1983. 309:1286–1290.

8. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update. 2004. 10:135–147.

9. Sperling M. Pediatric endocrinology. 2008. 3rd ed. Philadelphia: WB Saunders Co;2565–2073.

10. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 1959. 2nd ed. California: Stanford University Press.

11. Bayley N, Pinneau SR. Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards. J Pediatr. 1952. 40:423–441.

12. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969. 44:291–303.

13. Garibaldi L. Kliegman R, Nelson WE, editors. Disorders of pubertal development. Nelson textbook of pediatrics. 2007. 18th ed. Philadelphia: Saunders Co;2309–2311.

14. Phillip M, Lazar L. Precocious puberty: growth and genetics. Horm Res. 2005. 64:56–61.

15. Paik KH, Jin DK. Etiology and age incidence of precocious puberty. J Korean Soc Pediatr Endocrinol. 2002. 7:199–205.

16. Shin CH, Hwang JS, Lim JS, Kim SY, Shim KS, Yang SW, Yu JS. Growth and growth-determining factors in girls with idiopathic central precocious puberty treated with long-acting luteinizing hormone-releasing hormone analogue. J Korean Soc Pediatr Endocrinol. 1997. 2:217–225.

17. Oerter KE, Manasco P, Barnes KM, Jones J, Hill S, Cutler GB Jr. Adult height in precocious puberty after long-term treatment with deslorelin. J Clin Endocrinol Metab. 1991. 73:1235–1240.

18. Antoniazzi F, Zamboni G. Central precocious puberty: current treatment options. Paediatr Drugs. 2004. 6:211–231.

19. Choi JH. Proper dosage and duration of GnRH agonist treatment in central precocious puberty. J Korean Soc Pediatr Endocrinol. 2006. 11:8–14.

20. Mul D, Hughes IA. The use of GnRH agonists in precocious puberty. Eur J Endocrinol. 2008. 159:S3–S8.

21. Weise M, Flor A, Barnes KM, Cutler GB Jr, Baron J. Determinants of growth during gonadotropin-releasing hormone analog therapy for precocious puberty. J Clin Endocrinol Metab. 2004. 89:103–107.

22. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, Oh K, Jang MJ, Hwang SS, Yoo MH, Kim YT, Lee CG. 2007 Korean National Growth Charts: review of developmental process and an outlook. Korean J Pediatr. 2008. 51:1–25.

23. Boepple PA, Mansfield MJ, Wierman ME, Rudlin CR, Bode HH, Crigler JF Jr, Crawford JD, Crowley WF Jr. Use of a potent, long acting agonist of gonadotropin-releasing hormone in the treatment of precocious puberty. Endocr Rev. 1986. 7:24–33.

24. Perry RJ, Farquharson C, Ahmed SF. The role of sex steroids in controlling pubertal growth. Clin Endocrinol (Oxf). 2008. 68:4–15.

25. Attie KM, Ramirez NR, Conte FA, Kaplan SL, Grumbach MM. 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. 71:975–983.

26. Rodd C, Jourdain N, Alini M. Action of estradiol on epiphyseal growth plate chondrocytes. Calcif Tissue Int. 2004. 75:214–224.

27. Arrigo T, Cisternino M, Galluzzi F, Bertelloni S, Pasquino AM, Antoniazzi F, Borrelli P, Crisafulli G, Wasniewska M, De Luca F. Analysis of the factors affecting auxological response to GnRH agonist treatment and final height outcome in girls with idiopathic central precocious puberty. Eur J Endocrinol. 1999. 141:140–144.

28. Klein KO, Barnes KM, Jones JV, Feuillan PP, Cutler GB Jr. Increased final height in precocious puberty after long-term treatment with LHRH agonists: the National Institutes of Health experience. J Clin Endocrinol Metab. 2001. 86:4711–4716.

29. 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. 92:3483–3489.

30. Oostdijk W, Drop SL, Odink RJ, Hummelink R, Partsch CJ, Sippell WG. 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.