Carel Jean-Claude, Lahlou Najiba, Roger Marc, Chaussain Jean Louis
Groupe hospitalier Cochin-Saint Vincent de Paul, Faculté Cochin - Université Paris V and INSERM U561, Paris.
Hum Reprod Update. 2004 Mar-Apr;10(2):135-47. doi: 10.1093/humupd/dmh012.
Precocious puberty results mostly from the precocious activation of the gonadotropic axis. Although the age limits have recently been discussed, most physicians consider that onset of pubertal development before the age of 8 years in a girl or 9 years in a boy warrants at least a clinical and bone age evaluation by a paediatric endocrinologist. The major concern in precocious puberty is the underlying condition, and central nervous system or gonadal neoplasm have to be formally excluded as a first step in the diagnosis. A secondary concern is height, since precocious puberty leads to accelerated growth, accelerated bone maturation and ultimately reduced stature. Precocious puberty is heterogeneous and strict criteria should be used to define it, both in terms of age and in terms of potential for progression. Depot forms of GnRH agonists are now the standard treatment for progressive central precocious puberty and aim at alleviating the clinical symptoms of early pubertal development, their psychological consequences and the effects on growth. Here, we review the consequences of both central and gonadotropin-independent precocious puberty on adult stature and the information available on outcomes using the therapeutic regimens currently available. In girls with progressive precocious puberty, all published evidence indicates a gain of adult height over height predicted before treatment or over untreated historical controls. However, the apparent height gain (derived from the comparison of predicted and actual heights) is very variable, in large part due to the inaccuracy of height prediction methods. In girls with onset of puberty at the lower half of the normal age (8-10 years) distribution, trials using GnRH agonists have given negative results (no benefit of treatment). In boys, precocious puberty is rare and fewer results are available but point in the same direction. The most appropriate time for interrupting the treatment is still controversial. In conclusion, GnRH agonists restore adult height in children when it is compromised by precocious puberty.
性早熟主要是由促性腺轴的过早激活引起的。尽管最近对年龄界限进行了讨论，但大多数医生认为，女孩在8岁前或男孩在9岁前出现青春期发育就需要至少由儿科内分泌学家进行临床和骨龄评估。性早熟最主要的问题是潜在病因，在诊断的第一步必须正式排除中枢神经系统或性腺肿瘤。第二个问题是身高，因为性早熟会导致生长加速、骨成熟加速，最终身高降低。性早熟具有异质性，应使用严格的标准从年龄和进展可能性两方面来定义它。长效促性腺激素释放激素（GnRH）激动剂目前是进行性中枢性性早熟的标准治疗方法，旨在缓解青春期过早发育的临床症状、其心理影响以及对生长的影响。在此，我们回顾中枢性和非促性腺激素依赖性性早熟对成人身高的影响，以及使用目前可用治疗方案的结局信息。在患有进行性性早熟的女孩中，所有已发表的证据表明，与治疗前预测的身高或未治疗的历史对照相比，成人身高有所增加。然而，明显的身高增加（通过预测身高与实际身高的比较得出）差异很大，很大程度上是由于身高预测方法不准确。在青春期开始于正常年龄分布下半部分（8至10岁）的女孩中，使用GnRH激动剂的试验结果为阴性（治疗无益处）。在男孩中，性早熟很少见，可用的结果较少，但指向相同方向。中断治疗的最合适时间仍存在争议。总之，GnRH激动剂可恢复因性早熟而受损的儿童的成人身高。
