Central precocious puberty - treatment protocol
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Diagnosis of central precocious puberty (CPP) is made by a Paediatric Endocrinologist. This will include (but is not limited) to the following:
- Appropriate height assessments and clinical examination for CPP
- Bone Age X-ray
- Other imaging (MRI etc)
- Other blood tests as appropriate (thyroid function tests etc)
- GnRH Stimulation Test (see Gonadotrophin Releasing Hormone
(GnRH) Test in Children - available on ADHB policies, ADHB
- LH and FSH (Time zero, +30, +45, +60 min)
- Oestradiol/Testosterone at time zero. (note Oestradiol needs sensitive assay)
Children less than 2 years of age should be reviewed at a clinical case conference with specialist Paediatric Endocrinologists before starting treatment
Treatment of central precocious puberty
|Agent of choice||Lucrin (depot leuprorelin acetate) intramuscular injection (IM)|
|Second line||Zoladex (goserelin acetate) slow subcutaneous injection|
Due to greater ease of administration Lucrin is our first line agent 
Lucrin (depot leuprorelin acetate) IM 3 monthly (either 11.25mg or 22.5mg). The initial dose chosen is at the discretion of the referring consultant. Most children will achieve adequate pubertal suppression with 11.25 mg. Typically 85% of children are biochemically suppressed by 3 months and 95% by 6 to 12 months after starting treatment . However, some children may require higher doses because of more difficult to treat conditions (e.g. hypothalamic hamartomas) or because they are larger (e.g. some children over 8 years or > 1m2 body surface area).
First review at 6 months
(i.e. at the time of the 3rd injection)
Consultant clinical review plus LH and FSH level 1 hour after Lucrin (3rd injection)
- Dose adjustment if not suppressed (suppression defined as LH <2 iu/L) after 6 months of treatment.
- If already on 22.5 mg consider increased frequency; e.g. 2 monthly instead of 3 monthly.
- Review at 3 months may be appropriate for children with very advanced bone age or known difficult to control condition such as a hypothalamic hamartoma
First 12 months and ongoing
- Clinical review 3 monthly in the first year and if the child has well suppressed puberty clinically and biochemically, then doctor visits can be extended to 6 monthly thereafter.
- Check LH and FSH levels 1 hour post-Lucrin 6 monthly for the first year , then annually thereafter
- Annual bone age x-ray
If not biochemically suppressed AND there are signs of ongoing puberty or bone age advancement consider dose increase or frequency change as per information above.
- Mouat FM, Hofman PL, Jefferies C, Gunn AJ, Cutfield WS: Initial growth deceleration during GnRH analogue therapy for precocious puberty. Clin Endocrinol (Oxf) 2009;70:751-756.
- Carel JC, Blumberg J, Seymour C, Adamsbaum C, Lahlou N: Three-month sustained-release triptorelin (11.25 mg) in the treatment of central precocious puberty. Eur J Endocrinol 2006;154:119-124.
- Bhatia S, Neely EK, Wilson DM: Serum luteinizing hormone rises within minutes after depot leuprolide injection: implications for monitoring therapy. Pediatrics 2002;109:E30.
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- Date first published: 02 February 2015
- Date last published: 02 February 2015
- Document type: Clinical Guideline
- Services responsible: Paediatric Endocrinology
- Owner: Alister Gunn
- Editor: Greg Williams
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