Background: A 3.6-year-old Caucasian male presented with rapid onset of deep voice, facial hair, Tanner stage 2 testes, Tanner stage 3 pubic hair, penile length 9.5 cm, growth velocity (GV) 13.1 cm/year, and bone age 7 years. Evaluation was consistent with central precocious puberty and ruled out other pathology. Standard weight-based gonadotropin-releasing hormone agonist (GnRHa) therapy was initiated. GV increased to 16.6 cm/year, puberty advanced further, and bone age was 11 years at age 4.1 years. Predicted adult height was 28 cm < mid-parental height (MPH).
Objective and hypotheses: The objective was to suppress puberty. The hypothesis was that individualized GnRHa therapy would suppress puberty and optimize height potential.
Method: Leuprolide acetate depot-ped IM injections were increased from 11.25 mg every 28 days to 15 mg every 28 days. Due to continued progression of puberty, leuprolide was increased to 15 mg every 25 days. Growth and pubertal development were monitored closely.
Results: Individualized GnRHa therapy was well tolerated. Progression of puberty and bone age slowed significantly. When he was 11.8 years of age, bone age was 14.5 years, height was 14.2 cm below MPH, testes and pubic hair were T4, and treatment was discontinued. Puberty progressed over the next 2 years. Near final adult height was 4.6 cm below MPH.
Conclusion: This case demonstrates the long-term outcome of individualizing GnRHa therapy until pubertal suppression was achieved in a young male. No literature was identified on increasing GnRHa dose and frequency when standard therapy fails to suppress puberty, therefore further study is needed.
01 Oct 2015 - 03 Oct 2015