Effects Of HPGA Suppression On Final Adult Height Of Idiopathic Central Precocious Puberty Girls

ObjectiveThe previous research of our group found that gonadotropin releasing analogue（GnRHa）treatment could effectively improve the prediction of adult height（PAH）of idiopathic central precocious puberty（ICPP）girls,and the improvement of PAH was mainly due to the delayed development of bone age（BA）.It’s beneficial for delaying the progress of BA and improving PAH in children with appropriate individualized GnRHa dosage,which,could control uterine volumes（Vut）,ovarian volumes（Vov）,luteinizing hormone（LH）and follicle stimulating hormone（FSH）within a certain range.But due to the limited observation time,we only studied the relationship between PAH and hypothalamus pituitary gonadal axis（HPGA）suppression at that time.The aim of this study is to verify the previous research conclusions through further follow-up until the children reach their final adult heights（FAH）,then to explore the relationship between the different HPGA suppression after GnRHa treatment and the final adult height FAH of ICPP girls,and to explore the optimal degree of HPGA suppression.Contributing to the individual adjustment of clinical GnRHa dosage,it will improve the final adult height of the child as much as possible,and avoid the combined use of recombinant human growth hormone（rhGH）.MethodsThere were 208 ICPP girls who received GnRHa treatment from September 2009to December 2018 in our hospital’s special disease clinic recruited in the study.We record the children’s height,weight,BA,Vut,Vov,basic values of LH,basic values of FSH,peak LH,peak FSH,E₂levels,etc.at different time points during GnRHa treatment;as well as those indicators at time of drug withdrawal;follow-up of children’s data including menarche age,FAH,weight and other indicators after drug withdrawal.IBM SPSS Statistics 26 software was used to analyze the collected data.Paired t test was used to comparison of the mean improvement of FAH and FAH in children.The comparison of the improvement of FAH and FAH in different courses of treatment between groups was performed by analysis of variance.Pearson correlation test was used to analyze the influencing factors of children’s height improvement.And according to the improvement of children’s height,threshold effect analysis was used to find the best degree of HPGA suppression.ResultsChildren’s FAHs after GnRHa treatment had significantly improved compared with PAH before treatment.There were statistical differences of improved（35）FAHs（FAH-PAH₀）among different courses（P<0.05）.（35）FAHs were negatively correlated with changed BAs（（35）BA=BA at the time of drug withdrawal-BA at the beginning of treatment）,but（35）FAH had no direct correlation with average Vut,average Vov,average values of LH、FSH during treatment.（35）BA was positively correlated with average Vut,Vov,values of LH、FSH during treatment（r=0.28,0.19,0.18,0.30;P=0.019,0.005,<0.001,0.012;respectively）.Threshold effect analysis showed that during treatment,controlling Vut within 1.3～1.6ml,Vov within 1.4ml,value of LH below 2.1 IU/L,and value of FSH below 2.4 IU/L was beneficial to slowing down bone age development and improving the FAH of the child.ConclusionGnRHa treatment can effectively improve the FAH of ICPP girls.During treatment process,selecting the appropriate dose of GnRHa can control Vut,Vov,value of LH,and value of FSH within certain ranges.It’s beneficial to slow down the progress,of bone age,thereby improving the FAH and reducing the use of rhGH.