Endocrine Abstracts

JOINT615

Introduction: Gonadotropin-releasing hormone (GnRH) analogs are critical in managing central precocious puberty (CPP) in pediatrics, effectively halting pubertal progression and improving predicted adult height. Despite their clinical benefits, potential risks such as bone mineral density reduction, metabolic disturbances, and menstrual irregularities require careful evaluation, especially in long-term use. This review synthesizes recent literature to provide a detailed understanding of GnRH analogs’ efficacy, safety, and potential side effects in pediatric applications.

Objectives: To evaluate the efficacy and safety of long-acting (3-month) vs short-acting (1-month) GnRH analogs in managing CPP in children, with a focus on growth outcomes, metabolic impacts, and side effects.

Methods: A literature review from 2009 to 2023 identified peer-reviewed studies assessing GnRH analog treatments in pediatrics. Key inclusion criteria included studies reporting clinical outcomes such as pubertal suppression, height outcomes, and metabolic effects. Table 1 provides an overview of the main findings from selected studies.

Results: • Efficacy: Long-acting GnRH analogs effectively suppressed pubertal progression and improved predicted adult height, comparable to monthly formulations. Ramos et al. (2021) reported an increase in height SDS and a reduction in BMI in 22 CPP patients treated with a 3-month formulation. Klein et al. (2020) showed effective pubertal suppression with 6-month leuprolide acetate. (Ramos et al., 2021), (Klein et al., 2020).

• Safety:.

• Bone health: Both 1-month and 3-month formulations had minimal impacts on bone density (Vatopoulou et al., 2020).

• Glucose metabolism: No significant alterations were reported (Yuan et al., 2015).

• Side effects: Some studies noted minor BMI increases and transient menstrual irregularities during initiation.

• Risks: Long-term suppression with depot preparations raised concerns about delayed recovery of the hypothalamic-pituitary-gonadal axis upon cessation, though these effects were largely reversible (Silverman et al., 2015).

Discussion: Both long-acting and short-acting GnRH analogs provide effective CPP management in pediatrics. Long-acting formulations offer enhanced compliance due to reduced injection frequency, which is particularly beneficial in children. However, they may pose challenges for quick dose adjustments and recovery post-treatment. Short-acting formulations allow for greater flexibility but require more frequent clinic visits, potentially affecting compliance.

Conclusions: GnRH analogs are highly effective and safe in managing CPP in pediatric populations. Long-acting formulations improve compliance and are well-tolerated, making them preferable in many cases. Monitoring for rare side effects, such as bone density loss or delayed recovery post-treatment, remains essential. Future research should explore long-term outcomes to optimize treatment strategies.