ESPE Abstracts (2014) 82 P-D-2-2-543

Time to Menarche After Completing GnRH Agonist in Girls with Central Precocious or Early Puberty

Shin-Hee Kim, In-Ah Jung, Won Kyoung Cho, Kyoung Soon Cho, So Hyun Park, Min Ho Jung & Byoung Kyu Suh


Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea


Background: Treatment goals for central precocious puberty (CPP) in girls include preventing short final height due to early epiphyseal closure, and avoiding premature onset of menarche.

Objective and hypotheses: Our aim was to evaluate the timing of menarche and the associated factors among patients with idiopathic CPP or early-onset puberty (EP) who were treated with GnRH agonists (GnRHa).

Method: We analyzed clinical and laboratory data of 98 girls (78 CPP and 20 EP) who were treated with GnRHa. Cumulative incidence of menarche was calculated by Kaplan–Meier method.

Results: A total of 98 girls were followed for median 24.2 months (interquartile ranges (IQR), 14.3–32.2). At the initiation of treatment, the median chronological (CA) and bone age (BA) were 8.7 years (IQR, 8.2–9.3) and 12 years (IQR, 11.5–12) respectively. The median treatment duration for whole cohort was 2.9 years (IQR, 2.3–3.5). Of the 98 girls, 57 (58%) reported menarche after completing GnRHa treatment. Among these 57 girls, median interval between end of treatment and onset of the menarche was 13.4 months (IQR, 9.4–18.5). Cumulative incidence rate of onset of menarche was 31% at 12 months, 51% at 15 months, 61% at 18 months, and 82% at 24 months after completing treatment. In univariate analysis, factors associated with the time to menarche included BMI SDS at start of treatment (hazard ratio (HR), 1.33; 95% CI, 1.003–1.77), LH/FSH ratio at start of treatment (HR, 1.34; 95% CI, 1.04–1.72) and BMI SDS at end of treatment (HR, 1.88; 95% CI, 1.34–2.64). Multivariate analysis indicated only one risk factor was BMI SDS at end of treatment (HR, 1.02; 95% CI, 0.99–1.04).

Conclusion: These results suggest that hormonal and auxological parameters at start as well as at end of treatment are related to time of menarche.

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