Purpose: The goal of treatment for true precocious puberty (TPP) and early puberty with GnRH agonist (GnRHa) is to prevent loss of genetic potential of target height (TH). And to regress secondary sex characteristics appropriate for patients age. But some patients growth velocity (GV) after treatment would decline and suggest that final height (FH) was not improved. So, we investigated the effect of combined GH and GnRHa treatment for near-FH (NFH) improvement.
Methods: In this retrospective study, we collected data on the 167 girls with TPP (139 treated with only GnRHa (Group 1) and 28 treated with GnRHa and combined GH over 1 year (Group 2)) who diagnosed with LH level over 5 IU/ml and two- to threefold increment compared basal level after GnRH stimulation test. NFH was investigated after menarche at least 1 year has elapsed from 32 patients. 22 patents with NFH treated with only GnRHa are included Group 3. And eight patients with NFH treated with combined GnRHa and GH over 1 year are included Group 4.
Results: The chronological age at diagnosis were 8.25±1.10 years in Group 1 and 9.02±1.45 years in Group 2. The height SDS at diagnosis were −1.76±1.26 in Group 1, −0.59±0.97 in Group 2, showed significant difference (P<0.05). The predicted adult height (PAH) SDS at diagnosis were −1.76±1.26 in Group 1, −2.82±1.53 in Group 2 with significant difference (P<0.05). After 1-year treatment, PAH SDS were −1.14±1.17 in Group 1, −1.71±1.29 in Group 2. After 2-year treatment, PAH SDS were −0.73±1.01 in Group 1, −0.50±1.40 in Group 2. After 3-year treatment, PAH SDS were −0.40±1.13 in Group 1, −0.50±1.05 in Group 2, appeared decreasing intergroup PAH difference. TH SDS at diagnosis were −0.50±0.504 in Group 3, −0.97±0.514 in Group 4, showed significant difference (P<0.05). After over 1year treatment, NFH SDS of Groups 3 and 4 were not statistically different.
Conclusion: The combined GH and GnRHa therapy in TPP and early puberty, whose PAH SDS or TH SDS were shorter than 5‰, could effective improving NFH in proportion to treatment duration.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology