Long-Term Treatment of Central Precocious Puberty with a Long-Acting Analogue of Luteinizing Hormone Release Hormone (D-Tryp⁶-GnRH) in Monthly Injections

Summary

The gonadotropin-releasing-hormone-like agonist D-Tryp⁶-GnRH (GnRHa) has been shown to induce reversible suppression of gonadotropins and gonadal steroids in patients with central precocious puberty. We examined the effect of a long-acting preparation of GnRHa in biodegradable microcapsules. D-Tryptophane⁶-GnRH, administered intramuscularly at 1 month intervals, for 12 consecutive months, on growth and skeletal maturation in 3 girls and 4 boys with neurogenic or idiopathic precocious puberty. Suppression of gonadotropin release after GnRH stimulation and gonadal steroids was maintained in all subjets. Growth velocity fell from a mean rate (±SEM) or 8.60±0.75 cm/year before treatment to 5.81±0.60 cm/year (p<0.005) after 1 year. Bone age advanced a mean of 8.0±0.45 months during treatment, suggesting an increase in predicted height from the ratio Δ bone age/Δ chronological age.

Two subjects, one of them with compensated Bartter's syndrome with normal hypothalamic pituitary-gonadal-axis, received the analogue to delay pubertal growth with the hope to improve final height. In the first one, the growth velocity fell from 9.9 cm/year to 8 cm/year and Δ bone age/Δ chronological age decreased from 1.28 to 1.0 and in the other subject, the growth velocity fell from 12 cm/year to 6.0 cm/year in the last year of treatment and Δ bone age/Δ chronological age fell from 3.2 to 0.75, indicating an improvement in predicted height.

Key words

Precocious Puberty - Luteinizing Hormone Releasing-Hormone-Analogue - Treatment