Gonadotropin releasing hormone analog treatment in children with congenital adrenal hyperplasia complicated by central precocious puberty
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Congenital adrenal hyperplasia (CAH) can be complicated by central precocious puberty (CPP) in children, which may compromise final height. We aimed to evaluate the effect of gonadotropin-releasing hormone analog (GnRHa) therapy on growth in children with CAH.
Twelve children with CAH were enrolled in a follow-up study. Eight patients underwent the GnRH stimulation test. GnRHa-treatment was administered at 3.75 mg every 4 weeks; the dose had to be increased to 7.5 mg in three patients. Bone age, growth velocities and body mass index of the patients were monitored during treatment.
Median chronologic age and bone age at diagnosis were 6.8 (3.5) years and 11 (1.2) years, respectively. Median follow-up was 4.4 (4.9) years. A significant difference was found in the median ratio of bone age to chronological age between diagnosis and last visit (p=0.005) and between the beginning of GnRHa treatment and last visit (p=0.004). Median growth velocity was 4 (2.5) cm, 3.4 (5.2) cm and 5.5 (5.5) cm at the end of the first, second and third years of the therapy, respectively. Second-year growth velocity was inversely correlated with median bone age at diagnosis (rho:−0.758, p=0.004) and at the initiation of therapy (rho:−0.876, p<0.001).
GnRHa therapy should be considered for augmentation of linear growth and diminishment of bone age advancement in children with CAH complicated by CPP, particularly in children who do not have extremely advanced bone age for chronological age.
Key wordsChildhood Congenital adrenal hyperplasia Leuprolide acetate Precocious puberty
- 1.White PC, Speiser PW, 2000 Congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Endocr Rev 21: 245–291.Google Scholar
- 11.Greulich WW, Pyle SI 1959 Radiographic atlas of skeletal development of the hand and wrist. Stanford University Press, Palo Alto.Google Scholar
- 13.Bonfig W, Schwarz HP, 2012 Overestimation of final height prediction in patients with classical congenital adrenal hyperplasia using the Bayley and Pinneau method. J Pediatr Endocrinol Met 25: 645–649.Google Scholar
- 16.Demirbilek H, Alikasifoglu A, Gonc NE, Ozon A, Kandemir N, 2012 Assessment of gonadotrophin suppression in girls treated with GnRH analogue for central precocious puberty; validity of single luteinizing hormone measurement after leuprolide acetate injection. Clin Endocrinol (Oxf) 76: 126–130.CrossRefGoogle Scholar