Pathophysiology of gonadotropin secretion in patients with idiopathic precocious puberty and follow up studies during and after therapy with medroxyprogesterone acetate (Japanese)

Abstract

In order to assess the pathophysiology of gonadotropin secretion in patients with idiopathic precocious puberty the responses of LH and FSH to LH releasing hormone (LH-RH), clomiphene citrate (Clomid) and medroxyprogesterone acetate (Depo provera) in 6 female patients were tested. The basal levels of serum LH and FSH were elevated in 4 of the patients and enhanced LH response to 100 μg of intravenous LH-RH was observed in 5 patients, while FSH response was comparable to that of prepubertal subjects. Administration of Clomid (50 mg) for 7 days provoked LH increase in 3 patients, in contrast to no LH change in normal prepubertal girls, while FSH levels decreased in 3 patients. Intramuscular injection of Depo Provera (100 mg) reduced LH and FSH levels in 4 patients. The Depo Provera therapy, in a dose of 75225 mg every two weeks, caused suppression of breast development and menstrual bleeding, but the prevention of growth spurt and bone age maturation was insufficient. Basal boby temperature charts in 2 patients showed an ovulatory pattern immediately following cessation of Provera therapy of more tan 8 years' duration. In conclusion, it is suggested that the function of the hypothalamo pituitary ovarian system in patients with idiopathic precocious puberty is similar to that of normal pubertal subjects, that the therapeutic doses of Depo Provera, enough to suppress the patients' secondary sex characteristics, were not sufficient to control bone age maturation, and that it is neccessary to follow up patients more closely by measuring serum levels of gonadotropin and estrogen during the course of therapy.