ESPE Abstracts

Central precocious puberty (CPP) caused by early maturation of the hypothalamic–pituitary–gonadal axis, resulting in early appearance of secondary sexual characteristics That affects children’s normal life and their adulthood’s final height. GnRH agonist therapy inhibits stimulating effects of endogenous GnRH by desensitizing hypophyseal gonadotropic cells and thus acceleration in bone maturation and early puberty is suppressed. So the aim of this longitudinal observational study is to assess the clinical, laboratory and radiological follow up of cases with CPP under treatment of GnRH agonist or after completion of treatment.

Methods: The study was conducted on (40) children (9 males, 31 females) diagnosed as CPP under or completed treatment of GnRH analogue by 3.75 mg monthly injection. All patients were assessed clinically by anthropometric measurements, predicted adult height PAH, Tanner stage of puberty at onset of treatment and after one year follow up. Laboratory (FSH, LH, 17 β-estradiol or testosterone according to sex) and radiological (MRI pituitary with contrast, pelvic US, bone age) were assessed

Results: the higher percentage (~78%) was for females with age of pubertal onset for both sexes (0.5-9 years) which was closely equal to age of onset of treatment, with duration of treatment (1.25-8 years). After one year of treatment, the percentage of females with breast (B) B2 decreased from 25.8% to 22.6%. Cases without menstruation increased from 71% to 100%. Pubic (P) hair P1 increased from 32.5% to 77.4% and P4 decreased from 17.5% to 3.2%. The percentage of male children with P3 decreased from 55.6% to 11.1% while there was no change in penile length or testicular volume. There was statistically significant increase in weight SDS, PAH, BMI, BMI SDS. While Ht SDS was significant decrease in females while there was no significant difference in males. There was statistically significant stoppage of accelerated bone age during follow up after treatment. There was statistically significant decrease of median FSH, LH, testosterone and 17β-Estradiol levels from baseline, 6 months and 12 months of treatment among studied groups. Abnormal MRI findings are detected among 47.5% of the cases at baseline that decreased to 27.5% after 12 months of treatment. There was statistically significant decrease in uterine length, uterine/cervical ratio. Also there was decrease of ovarian enlargement, ovarian follicles & cysts.

Conclusion: cases with CPP under treatment of GnRH agonist showed effective regression of pubertal changes which assessed clinical, laboratory and radiological.