Central precocious puberty: current treatment options.
Central precocious puberty: current treatment options.
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DOI：
10.2165/00148581-200406040-00002
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发表时间：
2004-01-01
期刊：
影响因子：
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通讯作者：
Zamboni, Giorgio
中科院分区：
文献类型：
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作者：
Antoniazzi, Franco;Zamboni, Giorgio
中枢性性早熟（CPP）的特征是青春期早期变化，生长速度加快，骨快速成熟，通常导致成年身高降低。应始终评估女孩在8岁之前和男孩在9岁之前出现青春期体征的情况。临床体征、骨龄、女孩的盆腔回声描记术和激素数据的组合需要诊断CPP并做出关于进展和预后的判断。并不是所有明显的CPP患儿都需要医疗干预。治疗的主要原因是防止成年身高受损，避免心理或行为问题。由于生长原因需要治疗是基于预测的成年身高的估计，发现身高潜力降低，这可能需要随访。基于心理和行为异常的治疗指征必须根据个人情况确定。治疗的主要短期目标是阻止第二性征和月经（女孩）的进展，并在已知的情况下治疗根本原因。长期目标是增加最终的成人身高和促进心理健康。一旦确定治疗合适，应立即开始使用长效促性腺激素释放激素（GnRH）激动剂。在几乎所有CPP患者中，这些化合物均能有效抑制垂体性腺功能。目前可获得CPP患者接受GnRH激动剂治疗20年的长期数据。治疗保留了大多数患者的身高潜力（特别是年轻患者），并改善了快速进展CPP儿童的最终成人身高，治疗后下丘脑-垂体-性腺轴完全恢复。使用长效制剂的GnRH激动剂治疗是有用的，具有良好的安全性，不良反应最小，无严重的长期后果。虽然还需要进一步的数据，但在未来，生长激素（生长激素）和GnRH激动剂联合治疗对一些生长速度明显受损的患者可能会发挥作用。GnRH拮抗剂的引入可能会改善CPP的治疗选择。
Central precocious puberty (CPP) is characterized by early pubertal changes, acceleration of growth velocity, and rapid bone maturation that often result in reduced adult height. An onset of pubertal signs before the age of 8 years in girls and 9 years in boys should always be evaluated. A combination of clinical signs, bone age, pelvic echography in girls, and hormonal data are required to diagnose CPP and make a judgment concerning progression and prognosis. Not all children with apparently true CPP require medical intervention. The main reasons for treatment are to prevent compromised adult height and to avoid psychosocial or behavioral problems. The need for treatment for auxologic reasons is based on estimation of predicted adult height, with the finding of a reduced height potential, which may require a follow-up. Indication for treatment on the basis of psychologic and behavioral anomalies has to be determined on an individual basis. The main short-term aims of therapy are to stop the progression of secondary sex characteristics and menses (in girls) and to treat the underlying cause, when known. Long-term goals are to increase final adult height and to promote psychosocial well-being. Once it has been decided that treatment is appropriate, it should be initiated immediately with depot gonadotropin-releasing hormone (GnRH) agonists. The effective suppression of pituitary gonadal function is achieved with these compounds in practically all CPP patients. Long-term data are now available from 2 decades of GnRH agonist treatment for patients with CPP. Treatment preserves height potential in the majority of patients (especially in younger patients) and improves the final adult height of children with rapidly progressing CPP, with a complete recovery of the hypothalamic-pituitary-gonadal axis after treatment. GnRH agonist treatment using depot preparations is useful and has a good safety profile, with minimal adverse effects and no severe long-term consequences. Although further data are need, there may be a role in the future for combining somatropin (growth hormone) and GnRH agonist treatment for some patients with significantly impaired growth velocity. The introduction of GnRH antagonists is likely to improve the treatment options for CPP.