Journal of Clinical Endocrinology & Metabolism, Vol 67, 368-372, Copyright © 1988 by Endocrine Society

ARTICLES

Resumption of puberty after long term luteinizing hormone-releasing hormone agonist treatment of central precocious puberty

PK Manasco, OH Pescovitz, PP Feuillan, KD Hench, KM Barnes, J Jones, SC Hill, DL Loriaux and GB Cutler Jr
Developmental Endocrinology Branch, National Institute of Child Health and Human Development, Bethesda, Maryland 20892.

To determine whether puberty resumes normally after long term LHRH agonist (LHRHa) treatment, we studied 16 children with central precocious puberty treated with LHRHa (D-Trp6,Pro9,NEt-LHRH) for 1-4 yr (mean, 3.3 yr). Treatment was discontinued at a mean age of 11.6 +/- 1.3 (+/- SD) yr. Plasma hormone levels, growth velocity, rate of bone maturation, and pubertal stage were assessed at the end of treatment and 3 and 12 months later. Basal plasma sex steroid and basal and LHRH- stimulated gonadotropin levels returned to near-pretreatment levels 3 months after discontinuation of therapy and were fully restored to pretreatment levels at 12 months. Growth velocity, which had been 7.8 cm/yr before treatment, was stable after discontinuation of treatment at approximately 2.6 cm/yr. The predicted height, which had increased during treatment (P less than 0.01), remained stable at approximately 5 cm above the pretreatment predicted height. The rate of bone age advancement (delta bone age/delta chronological age) increased gradually from 0.4 at the end of treatment to the normal value of 0.9 12 months posttreatment. Breast and pubic hair pubertal stages, which were stable throughout treatment and were 4.0 +/- 0.8 (+/- SD) and 3.6 +/- 1.0 at the end of treatment, increased to 4.9 +/- 0.2 and 4.5 +/- 1.0. This approximated the normal rate of 1 stage/yr. Menses occurred in 8 of 12 girls within 1 yr after treatment and in an additional 3 by 20 months after treatment. Six of the girls had menstruated before treatment, and all of these menstruated within 14 months after discontinuing therapy. We conclude that gonadotropin and sex steroid secretion and the clinical progression through puberty appear to resume normally after discontinuation of long term LHRHa treatment of central precocious puberty. Long term follow-up will be required, however, to determine whether the improvement in predicted height of these patients will be achieved, and whether adult reproductive function will be normal.

This article has been cited by other articles:

				A. M. Pasquino, I. Pucarelli, F. Accardo, V. Demiraj, M. Segni, and R. Di Nardo Long-Term Observation of 87 Girls with Idiopathic Central Precocious Puberty Treated with Gonadotropin-Releasing Hormone Analogs: Impact on Adult Height, Body Mass Index, Bone Mineral Content, and Reproductive Function J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 190 - 195. [Abstract] [Full Text] [PDF]

				J.-C. Carel, J. Blumberg, C. Seymour, C. Adamsbaum, N. Lahlou, and for the Triptorelin 3-month CPP Study Group Three-month sustained-release triptorelin (11.25 mg) in the treatment of central precocious puberty Eur. J. Endocrinol., January 1, 2006; 154(1): 119 - 124. [Abstract] [Full Text] [PDF]

				R. L. Rosenfield, N. Devine, J. J. Hunold, N. Mauras, T. Moshang Jr., and A. W. Root Salutary Effects of Combining Early Very Low-Dose Systemic Estradiol with Growth Hormone Therapy in Girls with Turner Syndrome J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6424 - 6430. [Abstract] [Full Text] [PDF]

				B. E. SPILIOTIS Gonadotropin-Releasing Hormone Analogues in the Management of Precocious Puberty Ann. N.Y. Acad. Sci., April 1, 2000; 900(1): 429 - 434. [Full Text] [PDF]

				Is Obesity an Outcome of Gonadotropin-Releasing Hormone Agonist Administration? Analysis of Growth and Body Composition in 110 Patients with Central Precocious Puberty J. Clin. Endocrinol. Metab., December 1, 1999; 84(12): 4480 - 4488. [Abstract] [Full Text]

				Long-Term Outcome after Depot Gonadotropin-Releasing Hormone Agonist Treatment of Central Precocious Puberty: Final Height, Body Proportions, Body Composition, Bone Mineral Density, and Reproductive Function J. Clin. Endocrinol. Metab., December 1, 1999; 84(12): 4583 - 4590. [Abstract] [Full Text]

				P. P. Feuillan, J. V. Jones, K. Barnes, K. Oerter-Klein, and G. B. Cutler Jr. Reproductive Axis after Discontinuation of Gonadotropin-Releasing Hormone Analog Treatment of Girls with Precocious Puberty: Long Term Follow-Up Comparing Girls with Hypothalamic Hamartoma to Those with Idiopathic Precocious Puberty J. Clin. Endocrinol. Metab., January 1, 1999; 84(1): 44 - 49. [Abstract] [Full Text]

				M. R. Palmert, S. Radovick, and P. A. Boepple The Impact of Reversible Gonadal Sex Steroid Suppression on Serum Leptin Concentrations in Children with Central Precocious Puberty J. Clin. Endocrinol. Metab., April 1, 1998; 83(4): 1091 - 1096. [Abstract] [Full Text]

				P. A. Lee Advances in the Management of Precocious Puberty Clinical Pediatrics, January 1, 1994; 33(1): 54 - 61. [PDF]