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The Acid-Labile Subunit of Human Ternary Insulin-Like Growth Factor-Binding Protein Complex in Girls with Central Precocious Puberty before and during Gonadotropin-Releasing Hormone Analog Therapy

Department of Pediatrics, IRCCS Policlinico S. Matteo, University of Pavia (M.C., M.D.), 27100 Pavia, Italy; Department of Pediatrics, University of Parma (S.B.), 43100 Parma, Italy; Department of Biomedicine of Developing Age, University of Bari (L.C.), 70100 Bari, Italy; Institute of Pediatrics, University of Messina (F.D.L.), 98100 Messina, Italy; Exacta Central Laboratories (A.L.) 37100 Verona, Italy; and Department of Pediatrics, Policlinico University of Verona (S.L., D.S., L.T.), 37100 Verona, Italy

Address all correspondence and requests for reprints to: Mariangela Cisternino, M.D., Department of Pediatrics, IRCCS Policlinico S. Matteo, Piazzale Golgi 5, 27100 Pavia, Italy. E-mail: m.cisternino{at}smatteo.pv.it.

Abstract

The aim of the study was to evaluate serum acid-labile subunit (ALS) concentrations and their relationship with other parameters of the human ternary IGF-I-binding protein (IGFBP) complex in girls with central precocious puberty (CPP) before and after pharmacological arrest of puberty. We studied serum ALS, free IGF-I, total IGF-I, IGFBP-3 levels and IGFBP-3 protease activity in 13 girls, aged 1.6–7.8 yr (mean, 5.9 ± 2.2), diagnosed as having CPP before and after 6 and 12 months of GnRH analog (GnRHa) therapy. The ALS SD score before treatment was high (1.4 ± 0.72) and decreased significantly after 6 and 12 months of GnRHa therapy [0.4 ± 0.54 (P < 0.01) and -0.4 ± 0.61 (P < 0.01), respectively]. Serum IGF-I and IGFBP-3 were also increased before treatment, but both of these factors remained elevated after 6 and 12 months of GnRH-A therapy [IGF-I SD score, 3.20 ± 1.64, 2.92 ± 1.82, and 3.68 ± 1.94 (P = NS), respectively; IGFBP-3 SD score, 1.02 ± 0.53, 0.94 ± 0.68, and 1.22 ± 0.87 (P = NS), respectively]. Serum free IGF-I levels and IGFBP-3 proteolytic activity did not vary significantly from their pretreatment values during GnRHa therapy. In conclusion, serum ALS levels were elevated in girls with CPP and decreased significantly during the first year of GnRHa therapy. Serum IGF-I and IGFBP-3 levels were also increased before therapy, but their levels were not influenced by treatment. The ALS decrease seems to be the sole GH-dependent factor that parallels the decreases in steroid levels and growth velocity during GnRHa therapy.

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