COMPLETE VERSUS INCOMPLETE GONADOTROPIN S UPPRESSION IN GIRLS WITH CENTRAL PRECOCIOUS PUBERTY - IMPACT ON GROWTH AND FINAL HIGHT-PREDICTION

Background: Whether short-acting or slow-release gonadotropin-releasin g hormone agonists have different effects on growth and bone maturatio n in children with central precocious puberty is still unknown. Method s: In a meta-analysis, we studied 21 previously untreated girls with c entral precocious puberty treated with Buserelin and 22 previously unt reated girls with central precocious puberty treated with Decapeptyl D epot. Duration of treatment was at least 18 months in both groups. Res ults: At start of therapy, chronological age, bone age, height velocit y and pubertal stage were well comparable between the groups. During t he first 6 months of treatment, clinical and biochemical escapes from suppression were more frequent in the Buserelin group; height velocity and bone maturation (delta bone age/delta chronological age) remained significantly higher (p<0.0001 and p<0.01, resp.) in Buserelin than i n Decapeptyl Depot patients. In contrast to the Decapeptyl Depot group , in the Buserelin patients height standard deviation score for bone a ge did not change and predicted adult height decreased. From 6 to 18 m onths of therapy, the development of height velocity, delta bone age/d elta chronological age, standard deviation score for bone age and pred icted adult height showed an almost parallel course in both groups. He ight velocity and bone maturation tended to be faster in the Buserelin group. Mean predicted adult height rose significantly in the Decapept yl Depot group, but not in the Buserelin-treated girls. Conclusions: A slow-release gonadotropin-releasing hormone agonist appears to be sup erior to short-acting drugs not only in terms of long-term tolerance b ut also for achieving the auxological objectives in central precocious puberty therapy. This is mainly due to their faster and more complete suppression of gonadotropins during the first 6 months of treatment.