Background: Children affected by cerebral palsy (CP) could experience central precocious puberty (CPP) 20 times more than general population. Nevertheless, the treatment is challenging.
Objective and hypotheses: To compare CPP features and the effects of gonadotropin-releasing hormone agonist therapy (GnRHa) in children with CP and in controls.
Method: The study involved 16 children with CPP and CP (median age (range) at diagnosis of CPP: 7.2 years (2.78.9); two males) (group A) and 11 children with CPP but no CP (7.4 years (5.27.9); no males) (group B). Auxological, biochemical and instrumental data were collected at diagnosis of CPP and at two follow-up visits.
Results: At diagnosis of CPP, height-SDS-adjusted-for-target-height (H-TH) was lower in A than B (−0.15±1.78 vs 1.56±1.38, P 0.03), while BMI-SDS (0.24±1.15 vs 0.45±0.82, P 0.30) and the discrepancy between chronological and bone ages (1.25±1.01 vs 1.74±1.57 years, P 0.50) did not differ between groups. Basal LH (3.15±2.44 vs. 0.49±0.50 mUI/ml, P 0.009), estradiol levels (29.51±19.12 vs 12.65±6.94 pg/ml, P 0.001) and median ovarian volume (3.37±1.04 vs 1.92±0.75 ml, P 0.006) were significantly higher in A than in B. GnRHa was effective in both groups decreasing gonadotropins, estradiol and signs of pubertal progression. However, it affected differently growth: at second follow-up visit, H-TH (−1.43±1.43 vs 1.48±1.42, P 0.003) and Δ H-SDS (−1.20±1.31 vs 0.21±0.33, P 0.017) were lower in A than B.
Conclusion: CPP in CP seems to progress rapidly supporting the hypothesis of a more intense activation of hypothalamicpituitarygonadal axis. We demonstrated that growth failure could partially mislead the diagnosis of CPP in CP and seemed to worsen during follow-up despite GnRHa. The complex management of these patients should be considered when a decision to treat has to be performed. Parents should be adequately supported in order to ensure the best therapeutic choice for each case.
01 Oct 2015 - 03 Oct 2015