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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 only)
    - 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 [1]


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 [2]. 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 [3], 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.


  1. 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.
  2. 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.
  3. 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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Document Control

  • 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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