Effect of central precocious puberty and gonadotropin-releasing hormone analogue treatment on peak bone mass and final height in females

To evaluate the effect of central precocious puberty (CPP) and its treatment with gonadotropin-releasing hormone (GnRH) analogues on final height and peak bone mass (PBM), we measured lumbar bone mineral density (BMD) in 23 girls at final height. Patients were distributed in two groups. Group 1: 14...

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Bibliographic Details
Published in:European journal of pediatrics 1998-05, Vol.157 (5), p.363-367
Main Authors: BERTELLONI, S, BARONCELLI, G. I, SORRENTINO, M. C, PERRI, G, SAGGESE, G
Format: Article
Language:English
Subjects:
Adolescent
Age
Biological and medical sciences
Body Height - drug effects
Bone density
Bone Density - drug effects
Bone mass
Bone mineral density
Buserelin - therapeutic use
Child
Child, Preschool
Dual energy X-ray absorptiometry
Female
Females
Gonadotropin-releasing hormone
Gonadotropin-Releasing Hormone - analogs & derivatives
Gonadotropins
Height
Hormones
Hormones. Endocrine system
Humans
Medical sciences
Pharmacology. Drug treatments
Physical growth
Pituitary (anterior)
Puberty
Puberty, Precocious - drug therapy
Regression Analysis
Triptorelin Pamoate - therapeutic use
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Summary:To evaluate the effect of central precocious puberty (CPP) and its treatment with gonadotropin-releasing hormone (GnRH) analogues on final height and peak bone mass (PBM), we measured lumbar bone mineral density (BMD) in 23 girls at final height. Patients were distributed in two groups. Group 1: 14 patients with progressive CPP were treated with GnRH analogues; seven patients received buserelin (1600 microg/daily), subsequently switched to depot triptorelin (60 microg/kg/26-28 days); seven patients were treated with depot triptorelin (60 microg/kg/26-28 days); mean age of treatment was 6.2 years (range 2.7-7.8 years); the treatment was discontinued at the mean age of 10.1 years (range 8.7-11.3 years); final height was reached at the mean age 13.4 years (range 12.0-14.9 years). Group 2: 9 patients (mean age 6.5 years, range 4.8-7.7 years) with a slowly progressing variant of CPP were followed without treatment; final height was reached at the mean age 13.6 years (range 12.5-14.8 years). Lumbar BMD (L2-L4 by dual energy X-ray absorptiometry) was measured in all patients at final height. In group 1, final height (158.9+/-5.4 cm) was significantly greater than the pre-treatment predicted height (153.5+/-7.2 cm, P < 0.001), but significantly lower than mid-parental height (163.2+/-6.2 cm, P < 0.005). Subdividing the girls of group 1 according to the bone age at discontinuation of therapy (i.e. < or =11.5 years, n=5, or > or =12.0 years, n=9), the former patients had a final height significantly higher than the latter (163.7+/-3.9 cm vs 156.5+/-4.6 cm, P < 0.02). In group 2, final height (161.8+/-4.6 cm) was similar to the pre-treatment predicted height (163.1+/-6.2 cm, P=NS) and was not significantly different from mid-parental height (161.0+/-5.9 cm). BMD values (group 1: 1.11+/-0.14 g/cm2, group 2: 1.22+/-0.08 g/cm2) were not significantly different from those of a control group (1.18+/-0.10 g/cm; n=20, age 16.3-20.5 years) and the patients' mothers (group 1: 1.16+/-0.07 g/cm2, n=11, age 32.9-45.1 years; group 2: 1.20+/-0.08 g/cm2, n=7, age 33.5-46.5 years). In group 1, the girls who stopped therapy at a bone age < or =11.5 years had significantly higher BMD (1.22+/-0.10 g/cm2) compared to those who discontinued therapy at a bone age > or =12.0 years (1.04+/-0.12 g/ cm2, P < 0.05). In girls with progressive CPP, long-term treatment with GnRH analogues improves final height. A subset of patients with CPP does not require treatment because good statural outcome
ISSN:0340-6199
1432-1076
DOI:10.1007/s004310050831