Adult height of girls with gonadotropin-dependent precocious puberty treated with lower dose of one-month depot GnRH analogs: results of a multicenter study

BRITO VN; GRYNGARTEN M,; CUKIER P; LATRONICO AC; ROPELATO MG; ARNHOLD IJ; MENDONCA BB; ESCOBAR ME

Rio de Janeiro, Brasil

Congreso; International Congress of Endocrinology.; 2008

Background: Depot GnRH analogs are the first-line therapy for patients with gonadotropin-dependent precocious puberty (GDPP). To reach normal adult height (AH), i.e., within target height (TH) range, is one of the goals of the treatment. Objectives: To identify factors implicated in adequate AH achievement in a large cohort of girls with GDPP treated with lower dosage of depot GnRH analogs Patients and Methods: Sixty-seven girls with clinical and hormonal diagnosis of GDPP who were treated exclusively with lower dosage of one-month depot GnRH analogs (3.75 mg leuprolide acetate or 3.75 mg or tryptorelin; 83-147 µg/kg/mo) who reached AH were selected. TH range was defined as TH ± 8.5 cm. The mean AH and TH was compared by Student’s t-test. In addition, Pearson’s correlation and multiple linear regression was performed. Statistical significance was considered at p<0.05. Results: The mean chronological age (CA) at the start of therapy was 7.2 ± 2 yr and initial bone age (BA) was 10.3 ± 2.3 yr. The mean therapy period was 3.4 ± 1.8 yr. The mean height SDS was 1.9 ± 1.2 at start of therapy. The mean AH was 157.1 ± 6.9 cm (-0.8 ± 1.2 SDS) and mean TH was 158.5 ± 4.9 cm (-0.6 ± 0.8 SDS) (not statistically significant). TH range was achieved by 56 out of 67 (83.6%) of these girls. AH was negatively and significantly associated with the interval between pubertal onset and start of therapy (r=-0.45, p<0.0001), BA at the start of therapy (r= -0.26, p= 0.03) and CA at the end of therapy (r= -0.325, p<0.007). In contrast, AH was positively and significantly associated with height SDS at the start and end of therapy (r=0.562, p<0.00000001; r=0.763, p<0.00000001) and TH (r=0.47, p<0.00005). Multiple regression analysis revealed that the interval between pubertal onset and start of therapy, height SDS at the end of therapy and TH explained 67% of AH variance. Conclusions: Depot GnRH analogs at lower dosage were effective in restore genetic height potential in 83.6% of girls with GDPP. The main features determining satisfactory AH achievement were the shorter interval between pubertal onset and the start of therapy, higher height SDS at the end of therapy and TH. In contrast, advanced BA at start of therapy, lower height SDS at the start of therapy and advanced CA at the end of therapy were associated with a poorer AH attainment.