ESPE Abstracts (2019) 92 P1-409

Long-Term Outcome in Young Women Treated for Central Precocious Puberty

Nicola Improda1, Sara Alfano1, Federica Anselmi1, Valeria Gaeta1, Lorenzo Bufalo1, Fabiana Santamaria1, Raffaella Di Mase2, Mariacarolina Salerno1

1Pediatric Endocrine Unit, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy. 2Department of Pediatrics, University of Naples Federico II, Naples, Italy, Naples, Italy

Background: GnRH-analogs (GnRHa) are the recommended treatment for Central Precocious Puberty (CPP). Despite a normal long-term outcome is generally reported, reproductive function and emotional sphere in adulthood are still poorly evaluated.

Objective: To evaluate the general long-term outcome of young women with previous CPP treated with GnRHa.

Patients and Methods: A cohort of 63 young women (25.5 ± 5.31 years) with history of CPP treated with GnRHa were enrolled.

All subjects received diagnosis of CPP at a men age of 7.01±1.35 years, and were treated for 2.02±1.43 years. Mean chronological age and bone age (BA) at the end of treatment were 10.15±0.87 and 12.1±0.86 years respectively. Menarche occurred 15.5±9.59 months (range 2-43) after treatment was discontinued.

At the enrolment all subjects underwent the following evaluations: gynecologic and menstrual cycle pattern history; anthropometric measurements and physical examination including signs of hyperandrogenism; pelvic US; Female Sexual Function Index (FSFI) questionnaire to investigate sexual and emotional sphere.

Results: Adult height (AH) (158.4±6.3 cm) was within the genetic target (158.1±4.7 cm) and significantly higher than predicted stature at diagnosis (155±5.4 cm; P=0.0001).

Mean height gain (+3.1 cm) was negatively correlated with BA at the end of treatment (r: -0.3684; P=0.0035) and with uterine length at diagnosis (r: -0.29; P=0.025).

Height gain was higher in patients treated under 6 years (+4.3 cm) compared to those treated between 6-8 years (+2.0 cm, P <0.0001).

Overweight/obesity was detected in 36.5% of patients at diagnosis and increased up to 46% during treatment; however in adult age only 30.2% of subjects were overweight/obese.

Gynecologic history revealed that 34.1% had menstrual irregularities and 27.3% received diagnosis of PCOS.

Assessment of emotional and sexual sphere revealed dyspareunia in 100%, difficulties in reaching orgasm in 60%.

Only 10% of patients planned pregnancy (due to young age of most women) and none of them reported fertility problems.

Conclusions: Our study confirms that AH is normal in girls with CPP treated with GnRHa and that height gain is higher in patients treated before the age of 6 years.

An increase in BMI is observed during treatment, but this effect seems to be transient, with no increased risk of overweight/obesity in adulthood.

We observed an increased prevalence of PCOS compared to general population, and problems in affective-sexual sphere. Whether these findings are intrinsic to CPP per se or to GnRHa therapy require further studies.

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