ESPE Abstracts

Background and aims: Early puberty (EP) in girls, characterized by the onset of thelarche between 6 and 8 years of age and/or rapid pubertal progression, remains a topic of debate. This study aims to assess the clinical and hormonal characteristics of girls with early and fast puberty (FEP) and their response to treatment with GnRH analogs (GnRHa) on growth, pubertal progression, and bone maturation.

Methods: Data from 22 girls with FEP were analyzed. Clinical pubertal stage, hormonal levels, and ovarian volume (OV) measured by ultrasound were recorded at the presentation. The impact of 3 years of GnRHa treatment on growth in relation to mid-parental height, pubertal progression, and bone maturation was evaluated.

Results: At presentation, the girls' mean age was 7.7 ± 0.7 years, height standard deviation score (Ht-SDS) was 0.8 ± 0.9, and growth velocity (GV) was 8.7 ± 1.4 cm/year. Bone age was advanced by 1.9 ± 1 year compared to chronological age. The predicted final adult height (FA-Ht) was 155 ± 8 cm. After 3 years of GnRHa treatment (Triptorelin: 3.75 mg I.M. monthly), mean Ht-SDS decreased to 0.5 ± 1.5, with reduced GV (5 ± 1.5 cm/year) and deceleration of bone age (0.7 ± 0.8 years). Predicted FA-Ht improved to 159 ± 7 cm, surpassing their average mid-parental height (MPht) of 159 ± 4 cm. Breast development did not change during treatment. BMI-SDS significantly increased from 1.3 ± 0.7 to 1.7 ± 0.8 (P = 0.001). At presentation, the mean OV was 2.3 ± 1.2 mL, correlating with Tanner stages of breast and pubic hair (r = 0.34 and 0.56, respectively, P < 0.05) and hormonal profile (LH, FSH, 17β-estradiol, and IGF-1 levels; r = 0.80, 0.54, 0.485, and 0.40, respectively, P < 0.05). OV did not correlate with bone age. Larger OV at presentation was associated with reduced Ht-SDS after 3 years of GnRHa treatment (r =0.42, P < 0.01).

Conclusion: GnRHa therapy effectively attenuated rapid puberty progression, skeletal maturation, and GV/year in girls with FEP. It successfully increased predicted FA-Ht, often surpassing mid-parental height. Larger OV at presentation correlated with reduced Ht-SDS after 3 years of GnRHa treatment, highlighting its significance as a predictive marker. This study sheds light on the potential of GnRHa therapy in managing early and fast puberty and its impact on growth outcomes.