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      Gonadotropin Releasing Hormone Agonist Treatment for Central Precocious Puberty

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          Abstract

          Several methodological problems complicate the evaluation of final statural height (FH) benefit after treatment with gonadotropin releasing hormone (GnRH) agonists for central precocious puberty (CPP). Since no controlled study has been performed, we have to rely on indirect methods, comparison with predicted height or with historical controls. FH of 58 girls, uniformly treated with triptorelin slow release formulation (triptorelin-SR, Decapeptyl<sup>®</sup>) for CPP were compared with predicted height before treatment and with FH of an historical group of patients not treated with GnRH agonist. The comparison with predicted height revealed an improvement of 4.8 ± 5.8 cm; comparison with the historical control group showed a mean improvement of 8.3 cm. The post-treatment growth spurt (ΔFH – height at the end of treatment) was a strong predictor of FH in multivariate analysis. The data suggest that continuing treatment beyond the age of 11 in girls does not improve and could actually decrease FH.

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          Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network

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            Gonadotropin-releasing hormone and its analogs.

            GnRH and its analogues have led to exciting new avenues of therapy in virtually every subspecialty of internal medicine as well as in gynecology, pediatrics, and urology. Since their discovery in 1971, it has been demonstrated that GnRH and its analogues enable medical professionals to influence the hypothalamic-pituitary-gonadal axis in two distinct classes of therapeutic applications. The first provides natural sequence GnRH in a pulsatile fashion via portable infusion pumps to mimic the normal physiology of hypothalamic GnRH secretion and restores reproductive potential to infertile men and women with disorders of endogenous GnRH secretion. The second mode uses long-acting GnRH agonists administered in a depot delivery to produce a paradoxical desensitization of pituitary gonadotropin secretion which, in turn, results in a complete ablation of the reproductive axis. This biochemical castration induced by GnRH agonist administration is a safe, effective, complete, and reversible method of removing the overlay of gonadal steroids from a variety of diseases which they are known to exacerbate. These diseases include endometriosis and uterine fibroids in women, prostate cancer in men, and precocious puberty in both sexes. This review examines the physiologic and pharmacologic principles underlying the advances produced by these agents, the mechanism of action of GnRH and its analogues at the cellular level, and the individual therapeutic applications to which these analogues have been applied. Because virtually every subspecialty of medicine will be touched by the GnRH analogues, this review provides an overview and background of their use.
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              Author and article information

              Journal
              HRE
              Horm Res Paediatr
              10.1159/issn.1663-2818
              Hormone Research in Paediatrics
              S. Karger AG
              978-3-8055-7013-8
              978-3-318-00533-2
              1663-2818
              1663-2826
              1999
              November 1999
              17 November 2004
              : 51
              : Suppl 3
              : 64-69
              Affiliations
              Department of Paediatric Endocrinology and INSERM U342, Hôpital Saint Vincent de Paul, Paris, France
              Article
              53164 Horm Res 1999;51(suppl 3):64–69
              10.1159/000053164
              10592446
              © 1999 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 2, Tables: 4, References: 28, Pages: 6
              Categories
              Puberty

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