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November 1994

Long-term Follow-up and Final Height in Girls With Central Precocious Puberty Treated With Luteinizing Hormone—Releasing Hormone Analogue Nasal Spray

Author Affiliations

From the First Pediatric Clinic (Drs Cacciari, Cassio, Balsamo, Colli, Cicognani, and Pirazzoli), Prenatal Pathophysiology Unit (Drs Brondelli and Bovicelli), and Department of Radiology (Dr Tani), University of Bologna, and Central Laboratory (Dr Mandini), S. Orsola Hospital, Bologna, Italy.

Arch Pediatr Adolesc Med. 1994;148(11):1194-1199. doi:10.1001/archpedi.1994.02170110080014

Objective:  To evaluate clinical, hormonal, and auxologic features in a group of girls with central precocious puberty during and after long-term treatment with luteinizing hormone—releasing hormone analogue nasal spray.

Design:  Clinical survey, before-after trial.

Setting:  Pediatric Clinic, Endocrinological Center, University of Bologna (Italy).

Patients:  Forty-one girls with central precocious puberty were treated for 28 months (range, 12 to 60 months); 25 of them discontinued therapy at a mean chronological age of 10.0±0.9 years and were followed up for 25 months (range, 6 to 50 months). Twelve patients achieved adult height.

Intervention:  Buserelinacetate (D-Ser [TBU] LHRH Al-9EA) nasal spray; 1800 μg/d subdivided into six intranasal administrations of 300 μg each.

Measurements/Main Results:  Basal follicle-stimulating hormone, peak gonadotropin values (fluoro-immunoenzymatic method, Eurogenetics, Tessenderlo, Belgium; sensitivity was 0.5 IU/L for luteinizing hormone and 1IU/L for follicle-stimulating hormone), and estradiol (radioimmunoassay method, DPC Kit, Los Angeles, Calif; sensitivity was 11.01 pmol/L were significantly suppressed (P<.0001) as of the third month of treatment and increased significantly (P<.01) to pretreatment levels 6 months after discontinuation of therapy. Uterine and mean ovarian volumes, which were stable throughout treatment, appeared significantly higher (P<.05) than before treatment at only 6 months after stopping therapy. In patients with more advanced bone age (according to Greulich and Pyle) at onset of treatment, we observed a more significant improvement of SD score for height (Tanner). Mean adult height in our patients was 159.5±6.1 cm, and the variables that were significantly associated with final height were height age/bone age ratio at onset and target height (according to Tanner).

Conclusions:  Long-term buserelin treatment administered nasally is effective because of completeness of inhibition, quick reversibility after treatment is stopped, and lack of side effects. Its auxologic results are different depending on bone age advancement at onset, which represents a predictor of "therapeutic success." Further follow-up would be useful.(Arch Pediatr Adolesc Med. 1994;148:1194-1199)