Commentary on "Effect of gonadotropin-releasing hormone agonist treatment on near final height in girls with central precocious puberty and early puberty"

Article information

Ann Pediatr Endocrinol Metab. 2023;28(1):3-4
Publication date (electronic) : 2023 March 31
doi : https://doi.org/10.6065/apem.2321125edi05
Department of Pediatrics, Severance Children's Hospital, Institute of Endo crinology, Yonsei University College of Medicine, Seoul, Korea
Address for correspondence: Ahreum Kwon Department of Pediatrics, Severance Children's Hospital, Institute of Endocrinology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Email: armea@yuhs.ac

The definition of precocious puberty (PP) is the onset of secondary sex characteristics before the age of 8 in girls and 9 in boys. The periodic administration of gonadotropin-releasing hormone (GnRH) agonists are recommended for patients with PP as the condition not only causes psychosocial problems but also results in a loss of final adult height. Several studies evaluated the efficacy of GnRH agonists, particularly on final height, in patients with PP [1-3]. Recently, with the diversification of GnRH agonist types and the development of long-acting depots, a comparison was made between the efficacy of 1-month and 3-month depots of GnRH agonists in girls with central PP [4]. To achieve better final height, early initiation and a long duration of GnRH agonist treatment is recommended. The greatest benefit of GnRH agonist treatment is obtained in girls who begin treatment before the age of 6, while those who start treatment between the ages of 6 and 8 have varying outcomes [5,6].

In contrast, early puberty (EP) is defined as the onset of secondary sex characteristics between the ages of 8–9 years in girls and 9–10 years in boys. Although the rapid progression of puberty in patients with EP also leads to loss of their final height, the efficacy of GnRH agonist treatment in these patients on final height has not yet been sufficiently defined. In several studies, the final adult height was reported to be similar between the group treated with GnRH agonists and the group without treatment in girls with EP [7-9].

Yang et al. [10] conducted a study on the effect of GnRH agonist treatment on near final height in girls with both central PP (CPP) and EP. Their results demonstrated that GnRH agonist treatment improved near final height not only in the CPP group but also in the EP group. In the EP group, GnRH agonist treatment also delayed bone age, with a greater difference between bone age and chronological age at the treatment start resulting in a better final height gain. This study is significant as it indicates that GnRH agonist treatment may aid in maintaining final height in patients with EP. However, since this contradicts previous research, it is too soon to draw definitive conclusions. Thus, larger-scale case-control prospective studies are required to confirm the efficacy of GnRH agonist treatment in patients with EP.

Notes

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

References

1. Lee HS, Yoon JS, Park KJ, Hwang JS. Increased final adult height by gonadotropin-releasing hormone agonist in girls with idiopathic central precocious puberty. PLoS One 2018;13e0201906.
2. Cho AY, Ko SY, Lee JH, Kim EY. Effects of gonadotropin-releasing hormone agonist treatment on final adult height in boys with idiopathic central precocious puberty. Ann Pediatr Endocrinol Metab 2021;26:259–65.
3. Kendirci HNP, Ağladıoğlu SY, Baş VN, Önder A, Çetinkaya S, Aycan Z. Evaluating the efficacy of treatment with a GnRH analogue in patients with central precocious puberty. Int J Endo crinol 2015;2015:247386.
4. Jeon MJ, Choe JW, Chung HR, Kim JH. Short-term efficacy of 1-month and 3-month gonadotropin-releasing hormone agonist depots in girls with central precocious puberty. Ann Pediatr Endocrinol Metab 2021;26:171–7.
5. Lazar L, Padoa A, Phillip M. Growth pattern and final height after cessation of gonadotropin-suppressive therapy in girls with central sexual precocity. J Clin Endocrinol Metab 2007;92:3483–9.
6. Bar A, Linder B, Sobel EH, Saenger P, DiMartino-Nardi J. Bayley-Pinneau method of height prediction in girls with central precocious puberty: correlation with adult height. J Pediatr 1995;126:955–8.
7. Bouvattier C, Coste J, Rodrigue D, Teinturier C, Carel JC, Chaussain JL, 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;84:3575–8.
8. Kaplowitz PB, Backeljauw PF, Allen DB. Toward More targeted and cost-effective gonadotropin-releasing hormone analog treatment in girls with central precocious puberty. Horm Res Paediatr 2018;90:1–7.
9. Bertelloni S, Massart F, Miccoli M, Baroncelli GI. Adult height after spontaneous pubertal growth or GnRH analog treatment in girls with early puberty: a meta-analysis. Eur J Pediatr 2017;176:697–704.
10. Yang EH, Jo HY, Park SJ, Yoo HW, Choi SH, Kim HY, et al. Effect of gonadotropin-releasing hormone agonist treatment on near final height in girls with central precocious puberty and early puberty. Ann Pediatr Endocrinol Metab 2023;28:49–53.

Article information Continued