What is the management regimen for GnRH agonists in the treatment of precocious puberty?

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

For patients with precocious puberty treated with GnRH agonists:

  • Follow up every 4-6 months to ensure that progression of puberty has been arrested
  • Favorable signs include normalization of accelerated growth, reduction (or at least no increase) in breast size, and suppression of gonadotropin levels after a challenge of GnRH
  • The ideal testing frequency has not been established, although one approach is to obtain a GnRH test about 4 months after starting the drug to confirm suppression and then conduct such testing no more often than yearly, as long as clinical indicators suggest that the drug is working as intended; some clinicians advocate dispensing with formal GnRH testing as long as growth has slowed and breasts have decreased in size; in boys, a decrease in the size of the testes and a fall in the serum testosterone level to less than 20 ng/dL are good indications of efficacy
  • Monitor bone age yearly to confirm that the rapid advancement seen in the untreated state has slowed, typically to a half year of bone age per year or less

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