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      GnRH agonist treatment for idiopathic central precocious puberty can improve final adult height in Chinese girls

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          Abstract

          Object

          To study the outcomes of GnRHa on final adult height in Chinese idiopathic central precocious puberty (ICPP) girls and the involved factor(s) that can predict height gain.

          Methods

          We conducted a retrospective analysis on 10 years of data obtained from three clinical hospitals from January 2005 to March 2015, and 101 girls with ICPP, who received GnRHa therapy for more than six months and already reached their adult height were enrolled.

          Results

          Height, bone age, midparent height, HtSDS, sexual development, therapy duration and predicted adult height(PAH)at start and end of GnRHa, and the final adult height(FAH) were recorded and calculated. Their PAH significantly increased at end of GnRHa (158.4±6.00cm), compared to that at the start of GnRHa(153.1±5.37cm) ( P<0.001), and their final adult height(157.0±4.82) significantly increased compared to PAH at start of GnRHa(P<0.001). There was no difference between PAH at end of GnRHa and FAH( P>0.05). After GnRHa therapy, most of the ICPP girls reached their midparent height compared to that at start of GnRHa( P<0.01). FAH was positively correlated with Ht at start, and end of GnRHa, PAH at start and end of GnRHa, and also with midparent height ( R 2 =0.59, 0.74, 0.68, 0.73 and 0.80, P<0.001). While FAH was not correlated with the duration of treatment and BA at start of GnRHa(R 2 = 0.15and 0.1, P>0.05). The percentage of adult short stature decreased and those reached midparent height significantly increased after GnRHa therapy, compared to that at start of GnRHa(60.6% vs.30.4% and 67.85% vs. 94.64%, respectively, P<0.05).

          Conclusions

          GnRHa therapy to ICPP girls can effectively achieve the final adult height. After GnRHa therapy, most of these patients reached their midparent height, while few of these patients had an adult short stature.

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          Most cited references19

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          Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards.

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            Growth pattern and final height after cessation of gonadotropin-suppressive therapy in girls with central sexual precocity.

            The objective of the study was to determine whether height gain after discontinuation of gonadotropin-suppressive (GnRHa) therapy differs in girls with sexual precocity diagnosed at various ages and assess its influence on final height (FHt) outcome. We compared data on post-GnRHa treatment course and FHt of 115 girls [22 diagnosed before chronological age of 6 yr; 38 between ages 6 and 8 yr; and 55 early fast puberty (EFP) between ages 8 and 9 yr] treated with GnRHa from Tanner stage 2-3 to chronological age 11-12 yr and bone age 12-12.5 yr. Despite comparable bone age at cessation of treatment, similar time to resumption of puberty (0.6 +/- 0.7, 0.5 +/- 0.7, and 0.5 +/- 0.7 yr), and age at menarche (12.6 +/- 0.5, 12.6 +/- 0.6, and 12.7 +/- 0.9 yr), height gain from cessation of therapy to FHt was greater and time to epiphyseal fusion was longer in the younger central precocious puberty (CPP) than in the older CPP (P < 0.05) and EFP (P < 0.001) groups. The percentage of residual growth predicted at discontinuation of treatment was achieved only by the younger CPP (6.6 +/- 1.6% vs. 6.7 +/- 1.6%), whereas in older CPP and EFP, it was significantly lower (6.2 +/- 1.6% vs. 4.6 +/- 2.7% and 6.3 +/- 1.5% vs. 3.6 +/- 1.5%, respectively). FHt of these two groups was compromised, compared with FHt predicted at discontinuation of treatment (P < 0.01 and P < 0.001, respectively). Girls with sexual precocity diagnosed after the age of 6 yr exhibit earlier epiphyseal fusion with diminished posttreatment height gain and compromised FHt. Because recovery of gonadal axis was similar in all girls, differences were probably due to pretreatment intrinsic changes in the growth plate. Prediction of residual growth at discontinuation of treatment is unreliable in these girls.
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              Central Precocious Puberty: Update on Diagnosis and Treatment.

              Central precocious puberty (CPP) is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age. Most cases of CPP are seen in girls, in whom it is usually idiopathic. In contrast, ~50% of boys with CPP have an identifiable cause. The diagnosis of CPP relies on clinical, biochemical, and radiographic features. Untreated, CPP has the potential to result in early epiphyseal fusion and a significant compromise in adult height. Thus, the main goal of therapy is preservation of height potential. The gold-standard treatment for CPP is gonadotropin-releasing hormone (GnRH) analogs (GnRHa). Numerous preparations with a range of delivery systems and durations of action are commercially available. While the outcomes of patients treated for CPP have generally been favorable, more research about the psychological aspects, optimal monitoring, and long-term effects of all forms of GnRHa treatment is needed. Several potential therapeutic alternatives to GnRHa exist and await additional investigation.
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                Author and article information

                Journal
                Oncotarget
                Oncotarget
                Oncotarget
                ImpactJ
                Oncotarget
                Impact Journals LLC
                1949-2553
                12 December 2017
                20 November 2017
                : 8
                : 65
                : 109061-109067
                Affiliations
                1 Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                2 Department of Pediatrics, Jingzhou Maternal and Children Health Care Hospital, Jinzhou, China
                3 Department of Pediatrics, Sichuan Shuangliu Maternal and Children Health Care Hospital, Chengdu, China
                4 Department of Pediatrics, The First Affiliated Hospital of University of South China, Hengyang, China
                5 VA Boston Healthcare System, Department of Orthopedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
                Author notes
                Correspondence to: Yanqin Ying, yingyanqin_cn@ 123456163.com
                Article
                22568
                10.18632/oncotarget.22568
                5752503
                479afc07-9121-485f-a837-798e3e05550b
                Copyright: © 2017 Ying et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License 3.0 (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 22 March 2017
                : 3 September 2017
                Categories
                Research Paper

                Oncology & Radiotherapy
                idiopathic central precocious puberty,gonadotropin-releasing hormone agonist,final adult height

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