LONG-TERM FOLLOW-UP AND FINAL HEIGHT IN GIRLS WITH CENTRAL PRECOCIOUSPUBERTY TREATED WITH LUTEINIZING-HORMONE-RELEASING HORMONE ANALOG NASAL SPRAY

Objective: To evaluate clinical, hormonal, and auxologic features in a group of girls with central precocious puberty during and after long- term treatment with luteinizing hormone-releasing hormone analogue nas al spray. Design: Clinical survey, before-after trial. Setting: Pediat ric Clinic, Endocrinological Center, University of Bologna (Italy). Pa tients: Forty-one girls with central precocious puberty were treated f or 28 months (range, 12 to 60 months); 25 of them discontinued therapy at a mean chronological age of 10.0+/-0.9 years and were followed up for 25 months (range, 6 to 50 months). Twelve patients achieved adult height. Intervention: Buserelin acetate (D-Ser [TBU] LHRH Al-9EA) nasa l spray; 1800 mu g/d subdivided into six intranasal administrations of 300 mu g each. Measurements/Main Results: Basal follicle-stimulating hormone, peak gonadotropin values (fluoroimmunoenzymatic method, Eurog enetics, Tessenderlo, Belgium; sensitivity was 0.5 IU/L for luteinizin g hormone and 1 IU/L for follicle-stimulating hormone), and estradiol (radioimmunoassay method, DPC Kit, Los Angeles, Calif; sensitivity was 11.01 pmol/L) were significantly suppressed (P<.0001) as of the third month of treatment and increased significantly (P<.01) to pretreatmen t levels 6 months after discontinuation of therapy. Uterine and mean o varian volumes, which were stable throughout treatment, appeared signi ficantly higher (P<.05) than before treatment at only 6 months after s topping therapy. In patients with more advanced bone age (according to Greulich and Pyle) at onset of treatment, we observed a more signific ant improvement of SD score for height (Tanner). Mean adult height in our patients was 159.5+/-6.1 cm, and the variables that were significa ntly associated with final height were height age/bone age ratio at on set and target height (according to Tanner). Conclusions: Long-term bu serelin treatment administered nasally is effective because of complet eness of inhibition, quick reversibility after treatment is stopped, a nd lack of side effects. Its auxologic results are different depending on bone age advancement at onset, which represents a predictor of ''t herapeutic success.'' Further follow-up would be useful.