Endocrine Abstracts (2013) 32 P802 | DOI: 10.1530/endoabs.32.P802

GnRH analog treatment in children with congenital adrenal hyperplasia complicated by central precocious puberty

Ayla Guven, Ayse Nurcan Cebeci & Suna Hancili

Pediatric Endocrinology Clinics, Göztepe Education and Research Hospital, Istanbul, Turkey.

Introduction: In children with congenital adrenal hyperplasia (CAH), central precocious puberty (CPP) may occur and this situation may compromise final height. We aimed to evaluate the effect of GnRH analog therapy (GnRHa-T) on growth in children with CAH.

Design: Ten children with CAH were included in ongoing follow-up study. Nine children underwent GnRH stimulation test. GnRHa-T was used as 3.75 mg/q 4 weeks and the dose had to be increased to 7.5 mg/q 4 weeks in two children. Bone ages (BA), growth velocities (GV) and BMIs of patients during treatment were evaluated.

Results: On admission mean chronologic age (CA) and BA were 6.18±2.1 years and 10.5±2 years respectively. Five children have 46,XX karyotype, but one of them was reared as a male. Mean follow-up 4±1.8 years. A significant difference was found between mean BA/CA on admission and at last visit (P=0.002; t: 4933), and between mean BA/CA the beginning of GnRHa-T and at last visit (P=0.002; t: 4453). Mean CA was significantly increased in girls than boys at the beginning of GnRHa-T (8.37±0.9 vs 5.2±1.5 years; P=0.032).

GV was 5.96±2.2, 6.98±2.9 and 4.77±2.8 cm at the end of first (GV1), second (GV2) and third years of the therapy respectively. BMI was inversely correlated with GV1 (r: −0.818; P=0.007) and GV2 (r: −0.731; P=0.039). Mean CA at the beginning of GnRHa-T was negatively correlated with GV1 (r: −0.714; P=0.047) and GV2 (r: −0.927; P=0.003).

On admissionAt the beginning of GnRHa therapyAt last visit on therapy
Mean chronologic age (CA; years)6.18±2.16.78±1.810.1±2
Mean bone age (BA; years)10.5±211.2±1.712.3±2.1
Mean BA/CA1.93±0.61.7±0.41.22±0.2
Mean predicted height (cm)157.6±21161.3±11
Mean BMI–SDS0.62±0.670.77±0.9

Conclusion: GnRHa-T should be considered for augmentation of linear growth in children with CAH complicated with CPP, particularly in children with not too advanced BA for CA.

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