Growth, bone maturation and ovarian size in girls with early and fast puberty (EFP) and effects of three years treatment with GnRH analogue (GnRHa) Early and fast puberty (EFP) and GnRH analogue (GnRHa) treatment

Main Article Content

Nada Alaaraj
Ashraf T Soliman
Vincenzo De Sanctis
Noor Hamed
Fawziya Alyafai
Shayma Ahmed
Ahmed Khalil
Elsaid Bedair
Ahmed Elawwa

Keywords

Early and fast puberty (FEP), growth, bone maturation, ovarian size, GnRH analogue treatment

Abstract

Introduction: Early puberty (EP) in girls is defined as the onset of thelarche that begins after 6 years and before 8 years and/or acceleration in the tempo of pubertal development. The stage of puberty and the ovarian volume at presentation and the effect of treatment with GnRH analogue (GnRHa) on final adult height are still debated. Patients and methods: We analyzed the data of 22 girls, who presented early and fast puberty (FEP). The clinical stage of puberty, hormonal levels and the ovarian volume (OV) (measured by ovarian ultra-sonography) at presentation were studied. We recorded the effects of 3 years treatment with GnRHa on their growth in relation to their mid parental height, pubertal progression, and bone maturation. Results and conclusion: GnRHa therapy decreased the fast progress of puberty, skeletal maturation, and GV/year. It was successful in increasing the predicted final adult height comparable to or surpassing their mid-parenteral height. A larger OV at presentation was associated with reduced Ht-SDS after 3 years of GnRHa treatment. Clearly, a definitive evaluation of the efficacy of GnRHa as treatment for EFP in girls will require expanded and concerted studies.

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References

1. Harrington J, Palmert MR, Hamilton J. Use of local data to enhance uptake of published recommendations: an example from the diagnostic evaluation of precocious puberty. Arch Dis Child. 2014;99:15-20.
2. Bouvattier C, Coste J, Rodrigue D, et al. Lack of effect of GnRH agonists on final height in girls with advanced puberty: a randomized long term pilot study. J Clin Endocrinol Metab. 1999; 84:3575-3578.
3. Mul D, de Muinck Keizer-Schrama SM, Oostdijk W, Drop SL. Auxological and biochemical evaluation of pubertal suppression with the GnRH agonist leuprolide acetate in early and precocious puberty. Horm Res. 1999; 51:270-276.
4. Cassio A, Cacciari E, Balsamo A, Bal M, Tassinari D. Randomised trial of LHRH analogue treatment on final height in girls with onset of puberty aged 7.5-8.5 years. Arch Dis Child. 1999; 81:329-332.
5. Lebrethon MC, Bourguignon JP. Management of central isosexual precocity: diagnosis, treatment, outcome. Curr Opin Pediatr. 2000;12:394-399.
6. Lazar L, Kauli R, Pertzelan A, Phillip M. Gonadotropin-suppressive therapy in girls with early and fast puberty affects the pace of puberty but not total pubertal growth or final height. J Clin Endocrinol Metab. 2002;87:2090-2094.
7. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update. 2004;10:135-147.
8. Orr DP, Ingersoll GM. The contribution of level of cognitive complexity and pubertal timing to behavioral risk in young adolescents. Pediatrics. 1995;95:528-533.
9. Li P, Li Y, Yang CL. Gonadotropin releasing hormone agonist treatment to increase final stature in children with precocious puberty: a meta-analysis. Medicine (Baltimore).2014 Dec;93(27):e260. doi: 10.1097/MD.0000000000000260.
10. Haber HP, Wollmann HA, Ranke MB. Pelvic ultrasonography: early differentiation between isolated premature thelarche and central precocious puberty. Eur J Pediatr. 1995;154:182-186.
11. Salardi S, Orsini LF, Cacciari E, Bovicelli L, Tassoni P, Reggiani A. Pelvic ultrasonography in premenarcheal girls: relation to puberty and sex hormone concentrations. Arch Dis Child. 1985;60:120-125.
12. Garel L, Dubois J, Grignon A, Filiatrault D, Van Vliet G. US of the pediatric female pelvis: a clinical perspective. Radiographics. 2001;21:1393-407.
13. Badouraki M, Christoforidis A, Economou I, Dimitriadis AS, Katzos G. Evaluation of pelvic ultrasonography in the diagnosis and differentiation of various forms of sexual precocity in girls. Ultrasound Obstet Gynecol. 2008;32:819-827.
14. Cantas-Orsdemir S, Garb JL, Allen HF. Prevalence of cranial MRI findings in girls with central precocious puberty: a systematic review and meta-analysis. J Pediatr Endocrinol Metab. 2018;31:701-710.
15. Kaplowitz PB. Do 6-8 year old girls with central precocious puberty need routine brain imaging? Int J Pediatr Endocrinol. 2016;2016:9. doi:10.1186/s13633-016-0027-5.
16. Faizah M, Zuhanis A, Rahmah R, et al. Precocious puberty in children: A review of imaging findings. Biomed Imaging Interv J. 2012;8(1):e6. doi:10.2349/biij.8.1.e6.
17. Limony Y, Kozieł S, Friger M. Age of onset of a normally timed pubertal growth spurt affects the final height of children. Pediatr Res. 2015;78:351–355.
18. Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123:e752-e762.
19. Wang CL, Liang L, Liu PN, et al. [Effects of gonadotropin releasing hormone analog and growth hormone on height in girls with idiopathic central precocious puberty]. Zhongguo Dang Dai Er Ke Za Zhi. 2014;16:25-30.
20. Song W, Zhao F, Liang S, Li G, Xue J. Is a Combination of a GnRH Agonist and Recombinant Growth Hormone an Effective Treatment to Increase the Final Adult Height of Girls with Precocious or Early Puberty? Int J Endocrinol. 2018;2018:1708650. doi:10.1155/2018/1708650.
21. Soliman A, De Sanctis V, Elalaily R, Bedair S. Advances in pubertal growth and factors influencing it: Can we increase pubertal growth? Indian J Endocrinol Metab. 2014;18 (Suppl 1):S53-S62.
22. Kaplowitz PB. Link between body fat and the timing of puberty. Pediatrics. 2008;121 (Suppl 3):S208-217.
23. Karapanou O, Papadimitriou A. Determinants of menarche. Reprod Biol Endocrinol. 2010;8:115. Published 2010 Sep 30. doi:10.1186/1477-7827-8-115.
24. Shiasi Arani K, Heidari F. Gonadotropin-Releasing Hormone Agonist Therapy and Obesity in Girls. Int J Endocrinol Metab. 2015;13(3):e23085. doi:10.5812/ ijem. 23085v2.
25. Traggiai C, Perucchin PP, Zerbini K, Gastaldi R, De Biasio P, Lorini R. Outcome after depot gonadotrophin-releasing hormone agonist treatment for central precocious puberty: effects on body mass index and final height. Eur J Endocrinol. 2005;153:463-464.
26. Wolters B, Lass N, Reinehr T. Treatment with gonadotropin-releasing hormone analogues: different impact on body weight in normal-weight and overweight children. Horm Res Paediatr. 2012;78:304-311.
27. Yang WJ, Ko KH, Lee KH, Hwang IT, Oh YJ. The different effects of gonadotropin-releasing hormone agonist therapy on body mass index and growth between normal-weight and overweight girls with central precocious puberty. Ann Pediatr Endocrinol Metab. 2017;22:49-54.
28. Kelsey TW, Dodwell SK, Wilkinson AG, et al. Ovarian volume throughout life: a validated normative model. PLoS One. 2013;8(9):e71465. doi:10.1371/journal.pone. 0071465.
29. Khadilkar VV, Khadilkar AV, Kinare AS, Tapasvi HS, Deshpande SS, Maskati GB. Ovarian and uterine ultrasonography in healthy girls between birth to 18 years. Indian Pediatr. 2006 ;43:625-630.
30. Kaplowitz P, Bloch C; Section on Endocrinology, American Academy of Pediatrics. Evaluation and Referral of Children With Signs of Early Puberty. Pediatrics. 2016;137(1):10.1542/peds.2015-3732. doi:10.1542/peds.2015-3732.
31. Bourguignon J-P, Parent A-S (eds): Puberty from Bench to Clinic. Lessons for Clinical Management of Pubertal. Disorders. Endocr Dev. Basel, Karger. 2016;29: 214–229.
32. Mensah FK, Bayer JK, Wake M, Carlin JB, Allen NB, Patton GC. Early puberty and childhood social and behavioral adjustment. J Adolesc Health. 2013;53:118-124.
33. Cavanagh SE, Riegle-Crumb C, Crosnoe R. Puberty and the Education of Girls. Soc Psychol Q. 2007;70:186-198.
34. Roberts E, Joinson C, Gunnell D, Fraser A, Mars B. Pubertal timing and self-harm: a prospective cohort analysis of males and females. Epidemiol Psychiatr Sci. 2020 Oct 6;29:e170. doi: 10.1017/S2045796020000839.