Response of South Indian girls with central precocious puberty to gonadotrophin analogue (GnRHa) therapy – a single center experience

Abstract

Aim of the study: To describe the clinical, auxological, biochemical and radiological response to GnRH analogue in female children with central precocious puberty (CPP). Material and methods: The data on 22 female children presenting with the larche < 8 years, pubarche < 8 years or menarche < 9 years diagnosed as CPP was collected from the records over a four year period. Assessment included growth parameters, Tanners staging; bone age (BA) by Greulich and Pyle method, ultrasonography of abdomen to assess uterine length and ovarian size and z score derived; biochemical evaluation included serum luteinising hormone (LH), follicle stimulating hormone (FSH) and estradiol (E2); and MRI brain. The children were initiated on injection Leupride 0.9 mg/kg 3 monthly (body weight < 30 kg received 11.25 mg and > 30 kg received 22.5 mg). The predicted adult height (PAH) was calculated with Bayley Pinneau method. Results: Treatment was started at the mean chronological age (CA) of 6.09 ±2.1 years and continued till 8.3 ±2.4 years. MRI brain was abnormal in 4 children. Duration of treatment was 2.1 ±0.4 years. The height z scores reduced from 0.5 ±2.4 to 0.18 ±2.4 (p < 0.05). A significant reduction in tanner’s stage, uterine size and ovarian volume was observed in the study period. BA/CA ratio reduced from 1.27 ±0.4 to 1.07 ±0.3. PAH z score improved from 1.47 ±1.6 to 0.2 ±2.3 (p < 0.05). Conclusions: We observed a good clinical and radiological response to GnRHa therapy in girls with CPP and a significant improvement in PAH. Long term follow up is needed to assess the attainment of final height