Brauner R, Adan L, Malandry F, Zantleifer D
Pediatric Endocrinology Unit, Hopital et Faculté Necker-Enfants Malades, Paris, France.
J Clin Endocrinol Metab. 1994 Aug;79(2):415-20. doi: 10.1210/jcem.79.2.8045957.
GnRH analogs are used to suppress pituitary-gonadal activity in children with true precocious puberty. The indications for therapy in this situation are not established, as some girls have a slow evolutive form, and the capacity of GnRH analogs to preserve the adult height has not been evaluated. This study analyzes the growth and adult heights of 2 groups of girls with idiopathic true precocious puberty, 1 with a predicted height of 155 cm or less (group 1, 19 cases) and the other with a predicted height of more than 155 cm (group 2, 15 cases). Group 1 patients were treated with a long-acting GnRH analog (D-Trp6-GnRH), and group 2 patients were followed without therapy. Group 1 showed greater clinical signs of estrogenization, vaginal maturation index (P < 0.03), plasma estradiol (P < 0.0004), and ratio of LH/FSH peaks (P < 0.01) at the initial evaluation than did group 2. The mean target heights were similar (difference, 0.9 cm). In group 1, the adult height (159 +/- 1.1 cm) was greater than the predicted height before therapy (152 +/- 1.4 cm; P < 0.0001). The difference between the adult height and the predicted height before therapy (mean, 6.5 cm) correlated positively with the bone age advance (P < 0.01), negatively with the predicted height (P < 0.05), and positively with the difference between the target and predicted heights (P < 0.001) before therapy. In group 2, the adult height (162 +/- 1.4 cm) was similar to the predicted height at the initial evaluation (162.5 +/- 1.4 cm). Adult heights correlated with target height in group 1 and with predicted height at the initial evaluation in group 2. In conclusion, some girls with true precocious puberty and poor adult height prediction who are treated with GnRH analog achieve an adult height more comparable to their target height. However, the lack of effect on height in girls with predicted height at the onset of therapy similar to their target height and preservation of the growth potential in the slow evolutive forms suggest that these forms might not require immediate therapy. Careful follow-up before therapy may be a better way of evaluating their natural course.
促性腺激素释放激素（GnRH）类似物用于抑制真性性早熟儿童的垂体 - 性腺活动。这种情况下的治疗指征尚未确立，因为一些女孩具有缓慢进展型，且GnRH类似物对维持成年身高的能力尚未得到评估。本研究分析了两组特发性真性性早熟女孩的生长和成年身高，一组预测身高为155厘米或以下（第1组，19例），另一组预测身高超过155厘米（第2组，15例）。第1组患者接受长效GnRH类似物（D - Trp6 - GnRH）治疗，第2组患者未接受治疗而进行随访。在初始评估时，第1组比第2组表现出更明显的雌激素化临床体征、阴道成熟指数（P < 0.03）、血浆雌二醇（P < 0.0004）以及促黄体生成素/促卵泡生成素峰值比值（P < 0.01）。平均目标身高相似（差异为0.9厘米）。在第1组中，成年身高（159±1.1厘米）高于治疗前预测身高（152±1.4厘米；P < 0.0001）。成年身高与治疗前预测身高的差值（平均6.5厘米）与骨龄提前呈正相关（P < 0.01），与预测身高呈负相关（P < 0.05），与治疗前目标身高和预测身高的差值呈正相关（P < 0.001）。在第2组中，成年身高（162±1.4厘米）与初始评估时的预测身高（162.5±1.4厘米）相似。第1组成年身高与目标身高相关，第2组成年身高与初始评估时的预测身高相关。总之，一些真性性早熟且成年身高预测不佳的女孩接受GnRH类似物治疗后，成年身高更接近其目标身高。然而，治疗开始时预测身高与目标身高相似的女孩身高无变化，以及缓慢进展型女孩生长潜能得以保留，提示这些类型可能不需要立即治疗。治疗前仔细随访可能是评估其自然病程的更好方法。
