Gonadotropin-Releasing Hormone (GnRHa) Therapy for Central Precocious Puberty (CPP): Review of Nuances in Assessment of Height, Hormonal Suppression, Psychosocial Issues, and Weight Gain, with Patient Examples

This review suggests a central theme: that the treatment of each patient presenting with evidence consistent with central precocious puberty (CPP) needs to be individualized. This pertains to multiple factors relating to growth and growth potential, monitoring patients on treatment with gonadotropin-releasing hormone analogue (GnRHa), evaluating psychological issues with CPP and therapy, and concerns about weight gain during GnRHa therapy. Individual cases are presented. New data on adult height and rate of bone age advance are included. GnRHa treatment is effective in improving adult height in children with precocious onset of puberty, rapid progression, and good growth potential. Monitoring suppression adequacy involves a random LH level < 0.6 IU/L or a GnRHa-stimulated peak LH level < 4 IU/L as long as physical exam, growth rate, and rate of bone age progression, are also consistent with suppression. Abnormal psychosocial issues are rare with concerns primarily being related perceptions, real or perceived by others.