Effect analysis of gonadotropin-releasing hormone analogue in the treatment of idiopathic central precocious puberty in girls
Objective To investigate the effect of gonadotropin-releasing hormone analogue(GnRHa)in the treatment of idiopathic central precocious puberty(ICPP)in girls and its effects on body mass index and gonadal axis hormone levels.Methods A total of 42 girls with ICPP diagnosed and treated in the growth and development department of Kaiping Central Hospital from March 2021 to May 2023,were selected as the study subjects.The age was(7.5±2.3)years old,and the duration of disease was(10.98±2.75)months.All children were treated with GnRHa,with triptorelin acetate for injection as the main therapeutic drug,intramuscular injection,every 28 to 32 days.The first,second,and third doses were 3.75 mg(the maximum dose was not more than 180 μg/kg),and children with higher body mass could be strengthened with 1 injection at an interval of 21 days.The GnRH simple stimulation test was performed on the 14th day after the third injection,and the dose was adjusted to 80 to 100 μg/kg according to the results of luteinizing hormone(LH)peak(the maximum dose was not more than 3.75 mg).Their growth and development-related indicators such as height,body mass,bone age,and final adult height(FAH)were measured before treatment and 6 months after treatment.The changes in body mass index(BMI)and hormone levels such as follicle stimulating hormone(FSH),LH,and estradiol(E2)before and after treatment were compared.The changes in uterine volume,ovarian volume,and follicle diameter before and after treatment were observed,and the occurrence of adverse reactions was recorded.Wilcoxon signed rank sum test was used.Results After 6 months of treatment,the secondary sexual characteristics of the children were significantly suppressed,including 8 children with menstrual withdrawal and 34 children with staged breast withdrawal.After 6 months of treatment,the height,body mass,bone age,and FAH of the children were all higher than those before treatment[131.1(8.7)cm vs.127.8(8.2)cm,29.5(6.9)kg vs.27.0(5.5)kg,9.4(1.7)years vs.9.0(1.6)years,157.4(3.7)cm vs.154.9(2.8)cm](Z=-5.648,-5.600,-5.713,and-5.125,all P＜0.001);the standard deviation score of body mass index(BMISDS)had no significant change[16.7(1.6)kg/m2 vs.16.5(1.4)kg/m2](Z=-0.356,P=0.682).After 6 months of treatment,both uterine volume and ovarian volume decreased[2.1(1.6)ml vs.3.1(2.1)ml,1.2(0.9)ml vs.2.0(2.8)ml],and the follicle diameter decreased[3.0(1.3)mm vs.8.0(2.3)mm]compared with those before treatment,with statistically significant differences(Z=-5.646,-5.579,and-5.622,all P＜0.001).After three injections,the levels of E2,the peak of FSH activation,and the peak of LH activation were all lower than those before treatment[36.5(10.0)pmol/L vs.80.0(44.8)pmol/L,2.6(3.6)U/L vs.13.3(9.3)U/L,0.7(0.3)U/L vs.12.9(11.6)U/L](all P＜0.001).One child developed fat streaks on the buttocks,and the other children did not complain of discomfort during the treatment;there were no abnormalities in blood routine,liver and kidney function,or other related indicators.Conclusion The treatment of GnRHa in girls with ICPP can improve the FAH,has no significant effect on body mass index,and can inhibit the levels of gonadal axis hormones,which has good clinical efficacy and high safety.
Gonadotropin-releasing hormone analogueIdiopathic central precocious pubertyHypothalamic-pituitary-gonadal axisFinal adult heightBody mass indexGirls
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