The investigation of GnRH analog (Leuprolide acetate) treatment efficiency in girls with a central precocious puberty diagnosis

The investigation of GnRH analog (Leuprolide acetate) treatment efficiency in girls with a central precocious puberty diagnosis The aim: The goal is to investigate the treatment efficiency of girls with CPP diagnosis who were treated with GnRHa (Leuprolide acetate), by comparing anthropometric, laboratory and pelvic USG findings during the initial treatment and one, two and three year follow-up periods. Material and Methods: In this study, we retrospectively investigated 85 girls who were referred to the Department of Pediatric Endocrinology and Diabetes between January 2008 and December 2016, and who had central precocious puberty symptoms and treated with leuprolide acetate. The complaints at referral, the onset age of complaints, age at referral, back ground information, anthropometric measurements, physical examination findings, puberty stages, laboratory results and pelvic USG findings were recorded through the files of cases. The bone age of cases was determined from their left wrist graphics and predicted adult height (PAH) was calculated. The physical examination, anthropometric and hormonal measurements of cases who were under GnRHa treatment were performed at intervals of three months with three months. Pelvic USG and bone ages were evaluated with 6-month intervals. Findings: In cases treated with GnRHa, an idiopathic pathology was identified in 92.9% (79 cases) of them and an organic pathology was determined in 7% (6 cases) of them. Most of the cases were treated with low dose leuprolide acetate (3.75 mg / 4 weeks). Age of onset of treatment in cases treated for 3 years was significantly lower than the others (p <0.05). During treatment, a statistically significant increase was identified in CA/BA ratio at the end of first, second and third year with respect to the initial treatment value (p <0.05). When height was compared in terms of standard deviation score (SDS), there was no significant change in the first year, however, a statistically insignificant decrease in standard height SDS was detected at the end of the second and third year (p>0.05). In regard to baseline treatment values, a significant increase in PAH value at the end of the first, second and third year and a significant decrease in ΔTH-PAH difference was detected. There was a significant increase in BMI and BMI SDS values in cases who were under treatment for one and two years, however, no significant difference was detected in cases treated for three years. A significant increase in the standard deviation score of body weight was identified in cases who were under treatment for one year, however, an insignificant increase was observed in cases treated for two and three years. At the beginning of the treatment, the pubertal changes in inner genital organs were detected in 80% of cases (68 cases), assessed by pelvic USG. There was no significant change in uterine and ovarian size at the end of the first and second year according to pre-treatment findings, and a significant increase in uterine size was observed at the end of the third year. During the follow-up period, it was determined that there was a significant decrease in endometrial cavity thickness. In regard to baseline treatment values, it was observed that b LH, b FSH and b estradiol values reduced, and while a decrease in b FSH was found as significant, no significant difference was identified in the reduction of b LH and b estradiol values during the follow-up period. While there was a significant increase in the b LH / b FSH ratio at the end of the first year compared with pre-treatment to ratio, an insignificant decrease was observed at the end of the second and third year. Result: It was determined that there was a positive correlation between the treatment duration and suppression at the rate of BA progression, and increase in PAH and convergence of PAH to TH in girls with a CPP diagnosis. It was considered that the cases under treatment for three years could attain the adult height potential due to the similarity of the TH and PAH. Therefore, in order to minimize the risk of adult height loss in cases with CPP, it was identified that treatment should be started at an earlier age and that treatment should last for at least three years, as determined in some previous studies. Although a short-term GnRHa treatment had a negative effect on BMI, no adverse effect of long-term treatment on BMI was observed. In girls with CPP, the treatment with leuprolide acetate was identified as a reliable and useful treatment for conservation of the adult height. Key Words: Body mass index, bone age, central precocious puberty, girl, leuprolide acetate, predicted adult height, target height.