Predicted mature height in true precocious puberty

الملخص EN

Currently, lutenizing hormone releasing hormone agonists (LHRH-a) represent the treatment of choice for true precocious puberty (TPP), causing effective suppression of clinical signs of sexual maturation, decreased rate of epiphyseal maturation, reduction in growth velocity and improvement of adult height.

The aim of the present study is to determine the mature height potential in patients with central precocious puberty (CPP) treated with LHRH analogue therapy and also to correlate mature height potential with other variables at onset which may predict its prognosis.

A retrospective-prospective study was carried out for subjects with TPP of both sexes.

Auxological assessment included target height, height, height velocity, and pubertal assessment.

Skeletal maturity was assessed by Greulich and Pyle method with calculation of bone age advancement(BA-CA), (BAJCA).

Predicted adult height was calculated from Bayley and Pineau tables.

The study comprised 34 patients, 23 females (67.6%) and 11 males (32.4%).

Of all patients: 26(76.4%) had genuine TPP while 8 (23.6%) had true on top of pseudoprecocious puberty due to congenital adrenal hyperplasia caused by 21 hydroxylase deficiency.

Patients with genuine TPP had a mean chronological age at presentation of 4.3 ±2.6 years, mean chronological age at onset of treatment by LHRH analogue was 4.6 ±2.2years with a mean delay of treatment 2.3 ±1.8 years.

The mean duration of LHRH-a therapy was 3.2 ± 2.2 years.

Bone age advancement was evident in patients under study: mean BAJCA was 2.1 ±1.2 while mean BA-CA was 2.8 ±1.6 years.

Correlation between predicted adult height (PAH) at the last visit in patients with TPP and different variables revealed a positive correlation with height SDS at presentation with statistical significance(r=0.6, p=0.004).

Patients who reached final or near final adult height(FAH) in both groups of TPP or PPP were a total of 11: four males (36.4%) and seven females (63.6%).

They reached FAH at a mean CA of 11.07±1.4 years and a mean BA of 16.6±1.5 years.

Mean FAH in males was 149.7+5.4 cm(-4.2±l.l SDS) while in females group, mean FAH was 144.1±7.8 cm(-3.7±0.9 SDS).

This study emphasizes the importance of early diagnosis of TPP, regular evaluation and early intervention as well as proper selection of those who would really benefit from LHRH-a therapy before marked BA advancement occurs for optimization of the final adult height.