Background: GnRH-analogs (GnRHa) are the recommended treatment for Central Precocious Puberty (CPP). Despite a normal long-term outcome is generally reported, reproductive function and emotional sphere in adulthood are still poorly evaluated.
Objective: To evaluate the general long-term outcome of young women with previous CPP treated with GnRHa.
Patients and methods: A cohort of 63 young women (25.5±5.31 years) with history of CPP treated with GnRHa were enrolled. All subjects received diagnosis of CPP at a men age of 7.01±1.35 years, and were treated for 2.02±1.43 years. Mean chronological age and bone age (BA) at the end of treatment were 10.15±0.87 and 12.1±0.86 years respectively. Menarche occurred 15.5±9.59 months (range 2-43) after treatment was discontinued. At the enrolment all subjects underwent the following evaluations: gynecologic and menstrual cycle pattern history; anthropometric measurements and physical examination including signs of hyperandrogenism; pelvic US; Female Sexual Function Index (FSFI) questionnaire to investigate sexual and emotional sphere.
Results: Adult height (AH) (158.4±6.3 cm) was within the genetic target (158.1±4.7 cm) and significantly higher than predicted stature at diagnosis (155±5.4 cm; P=0.0001). Mean height gain (+3.1 cm) was negatively correlated with BA at the end of treatment (r: −0.3684; P=0.0035) and with uterine length at diagnosis (r: −0.29; P=0.025). Height gain was higher in patients treated under 6 years (+4.3 cm) compared to those treated between 68 years (+2.0 cm, P<0.0001). Overweight/obesity was detected in 36.5% of patients at diagnosis and increased up to 46% during treatment; however in adult age only 30.2% of subjects were overweight/obese. Gynecologic history revealed that 34.1% had menstrual irregularities and 27.3% received diagnosis of PCOS. Assessment of emotional and sexual sphere revealed dyspareunia in 100%, difficulties in reaching orgasm in 60%. Only 10% of patients planned pregnancy (due to young age of most women) and none of them reported fertility problems.
Conclusions: Our study confirms that AH is normal in girls with CPP treated with GnRHa and that height gain is higher in patients treated before the age of 6 years. An increase in BMI is observed during treatment, but this effect seems to be transient, with no increased risk of overweight/obesity in adulthood. We observed an increased prevalence of PCOS compared to general population, and problems in affective-sexual sphere. Whether these findings are intrinsic to CPP per se or to GnRHa therapy require further studies.
18 - 21 May 2019
European Society of Endocrinology