Effects Of HPGA Suppression On PAHs Of Girls With ICPP

ObjectiveTo investigate the relationship between suppression degree of the hypothalamus-pituitary gonadal axis(HPGA)and the predict adult height(PAH)of girls with idiopathic central precocious puberty(ICPP)during gonadotropin-releasing hormone analogue(GnRHa)treatment,and further to look for the best suppression range of HPGA to achieve the most PAH improvement by individualized GnRHa dose adjustment,at the meantime,to avoid the combination with recombinant human growth hormone(rhGH)therapy.MethodsThere were 158 female children who had been diagnosed with ICPP and received GnRHa(Diphereline)treatment alone from May 2009 to April 2016 recruited in the study.Their Clinical data were retrospectively collected,including ages,heights,body weights,bone ages(BA),body mass index(BMI),predicted adult heights(PAH),target heights(TH),uterine and ovarian volumes,basic values of LH?FSH,peak LH,peak FSH,E2 levels,menarche status before treatment.There were 158 girls received GnRHa treatment for more than 6 months,158 girls for 12 months,123 girls for18 months,93 girls for 24 months,63 girls for 30 months,39 girls for 36 months,17 girls for 42 months,6 girls for 48 months.At 6 months intervals of GnRHa treatment,heights,BAs,uterine and ovarian volumes,peak LH,peak FSH,E2 levels were recorded,PAHs at each time point were calculated,the relationships were analyzed between the improvement of PAH(?PAH=PAH-TH)and HPGA inhibition degree,and the best HPGA suppression ranges to guarantee ?PAH improvement were searched using the threshold effect analysis.ResultsAfter GnRHa treatment,PAHs were obviously improved compared with the pre-treatment data.Negative correlations between ?PAHs and ABAs were found,Uterine and ovarian volumes,values of LH?FSH?E2 were not related to ?PAHs.Pearson correlation analysis showed ABAs had no correlated with FSH values.After treatment,?BAs had positive correlation to uterine volume(r=0.17,P=0.035,n=158)at 12 months,to ovarian volune(r=0.34,P=0.001,n=93)at 24 months,to LH values(r=0.7,P=0.016,n=17)at 42 months.The volume of uterus between 1.2 and 1.8 ml,ovarian volume below 1.1 ml,LH level range from 0.4 to 1.8 IU/L,FSH below 2.5 IU/L would be most beneficial to slow the growth of BA and improve PAH.ConclusionGnRHa treatment can improve the PAH of CPP girls.Choosing appropriate GnRHa dosage to control uterus and ovarian volume,LH and FSH level within certain ranges can slow the growth of BA and improve PAH,avoiding the use of recombinant human growth hormone(rhGH).