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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 Function¹

Division of Pediatric Endocrinology, Department of Pediatrics, Christian Albrechts University of Kiel, D-24105 Kiel, Germany

Address all correspondence and requests for reprints to: Prof. Dr. Wolfgang G. Sippell, Division of Pediatric Endocrinology, Department of Pediatrics, Christian Albrechts University, Schwanenweg 20, D-24105 Kiel, Germany. E-mail: sippell{at}pediatrics.uni-kiel.de

A considerable number of patients with central precocious puberty (CPP) treated with depot GnRH agonists have reached final height (FH). The aim of this prospective, multicentric study was the evaluation of the benefits, side-effects, and long term outcome of depot GnRH agonist therapy. We investigated 50 young women (mean ± SD age, 16.7 ± 2.6 yr; range, 12.9–23.4 yr) at FH. They received depot triptorelin over a period of 4.4 ± 2.1 yr (range, 1.0–9.7 yr). Target height (TH) and predicted adult height (PAH) at the start of treatment were 163.6 ± 6.2 and 154.9 ± 9.6 cm, respectively (P < 0.05). FH was 160.6 ± 8.0 cm (FH vs. TH, P = NS; FH vs. PAH, P < 0.05). Young patients showed the highest height gain (FH minus initial PAH). Seventy-eight percent of all patients reached a FH within their TH range. Even in young patients and those with an unfavorable initial PAH below the TH range, 60% reached a FH within their individual TH range. Standardized bone mineral density and standardized bone mineral density SD score investigated by dual energy x-ray absorptiometry of the lumbar spine (L1–L4) were 1040.9 ± 124.2 mg/cm² and 0.0 ± 1.0; those of the femoral neck were 902.2 ± 115.4 mg/cm² and 0.2 ± 1.0, respectively. The SD score of the ratio of sitting height over lower leg length was normal (0.3 ± 1.2). Body mass index SD scores at pretreatment, at the end of treatment, and at FH were not significantly different (2.0 ± 2.0, 2.0 ± 2.0, and 1.7 ± 2.2, respectively). Menarche or remenarche started at age 12.3 ± 1.4 yr (range, 9.3–15.8 yr) in all patients.

In conclusion, long term depot GnRH agonist treatment of CPP girls preserved genetic height potential and improved FH significantly combined with normal body proportions. No negative effect on bone mineral density and reproductive function was seen. Treatment neither caused nor aggravated obesity.

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