Precocious Puberty Treatment & Management
- Author: Paul B Kaplowitz, MD, PhD; Chief Editor: Stephen Kemp, MD, PhD more...
When central precocious puberty (CPP) is caused by a CNS tumor other than a hamartoma, a resection should be attempted to the extent possible without impinging on vital structures such as the optic nerves. Radiation therapy is often indicated if surgical resection is incomplete. Unfortunately, removal of the tumor rarely causes regression of precocious puberty.
Patients treated with GnRH agonists
For patients with precocious puberty treated with gonadotropin-releasing hormone (GnRH) agonists:
Follow up every 4-6 months to ensure that progression of puberty has been arrested.
Favorable signs include normalization of accelerated growth, reduction (or at least no increase) in size of breasts, and suppression of gonadotropin levels after a challenge of GnRH.
The ideal testing frequency has not been established. A suggested timeline for girls is to obtain a GnRH test about 4 months after starting the drug to confirm suppression and then no more often than yearly, as long as clinical indicators suggest that the drug is working as intended. Some clinicians advocate dispensing with formal GnRH testing as long as growth has slowed and breasts have decreased in size. In boys, a decrease in the size of the testes and a fall in serum testosterone level to less than 20 ng/dL are good indications of efficacy.
Monitor bone age yearly to confirm that the rapid advancement seen in the untreated state has slowed, typically to a half year of bone age per year or less.
A literature review by Liu et al indicated that in girls with idiopathic central precocious puberty, treatment with a combination of GnRH analogue and growth hormone leads to better height results than does therapy with GnRH analogue alone while apparently causing no severe adverse effects.
Similarly, a literature review by Wang et al found that the addition of recombinant human growth hormone to GnRH agonist therapy resulted in significant height increase, as well as increases in predicted adult height and height standard deviation for bone age, in children with central precocious puberty. Efficacy was greater in patients whose initial treatment began prior to age 10 years or whose therapy lasted more than 12 months.
Patients not treated with GnRH agonists
In many cases, the physician may elect to observe the child with central precocious puberty (CPP), either because the age is borderline (ie, 7-8 y) and the child and family are coping well or because the progression of puberty is not rapid and the bone age is only mildly advanced (ie, ≤ 1 y), so that predicted adult height falls well within the reference range. In these cases, follow-up at 6-month intervals is appropriate. Testing and treatment may be initiated if the tempo of puberty begins to accelerate and predicted adult height deteriorates.
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