What is the prognosis of precocious puberty with treatment?

Updated: Nov 30, 2020
  • Author: Paul B Kaplowitz, MD, PhD; Chief Editor: Robert P Hoffman, MD  more...
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Answer

Most studies show significant improvement in adult height compared with height predicted at the start of therapy, but the extent of this improvement depends to some extent on the age of onset of CPP. [23] For example, a study from Israel showed that height gained in girls after discontinuation of GnRH analogue therapy at age 11-12 years (and bone age of 12-12.5 y) is greater for girls with onset of CPP before age 6 years than at age 6-8 years or after age 8 years. Mean adult height was better than genetic target height in the younger group and was less than target height in the group whose puberty started after age 8 years. [24]  This indicates that the benefit of treatment in terms of increased adult height is the greatest in patients who are diagnosed with CPP and started on GnRH analogues at younger ages. The lack of effect in the older girls was confirmed by a meta-analysis showing that treatment of mildly early puberty in girls (onset between ages 8 and 9 y) did not improve adult height. [25]

A review of the effects of GnRH analogue on adult height highlighted several problems with assessing outcomes. These include (1) a paucity of well-designed, randomized, controlled studies, and (2) problems in accurately estimating predicted height based on bone age readings, which may be differently interpreted by different readers. A table in this review summarizing 29 studies from 1994-2015 with differing patient populations found that the mean value for adult height after treatment minus predicted adult height based on bone age varied widely from 2-10 cm. [26]


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