Women's Corner
Women's Corner
A) The idea of treatment :
· Treatment of the cause
· Arrest maturation till normal pubertal development
· Diminish established precocious manifetations
· Maiximize eventual adult height
B) Gn-RH dependent precocious puberty :
GnRH analogues :
· Mechanism of action : After an initial flare, down regulation and desenstizaion follows
· Advantages :
1. Regression of established precocious manifestations
2. Prevents closure of the epiphysis . However the final bone height depends on the state the stage at which medication is begun , the bone age at which the drug is stopped and adequacy of treatment .
3. The effects are reversible after treatment i.e. stoppage of treatment is followed by reativation of the pubertal process and development of regulatory ovulatory function .
4. Effective with hypothalamic hamartoma thus avoiding risky surgery .
· Monitoring of therapy :
- Maintain estradiol level < 10 pg/ml
- Lack of gonadotropin response to GnRH adminstration
· Sustained release pellets (goserelin) or sustained release injections (leuprolide) allow once a month dosing . Treatment is continued till the epiphysis are fused or till appropriate chronological ages are matched .
· Disadvantages : Not effective in non-central causes as Albright syndrome or CAH
C) GnRH-independent : in addition to treatment of the cause
a. Isosexual : Medroxyprogesterone acetate :
· Mechanism : antiestrogen and inhibits gonadotropin release
· Dose : 300 mg/ 3months IM
· Disadvantages :
1. Undesirable side effects
2. Bone maturation and growth are not regularly controlled
3. Effects may take long time to be reversed after treatment
4. Unpredictable regression of 2nd ry sexual characters
b. Heterosexual : antiandrogens
D) Psychological support :
These children have behaviour keeping with their chronological age and not with physical or pubertal age . They do not early heterosexual activity or abnormal sexual libido .
- This should be explained to their parents
- Children should be counseled that their 2ndry sexual charcters are normal despite early
E) Incomplete precocious puberty :
Follow up at frequent intervals with evaluation if their is evidence of progression
D) Prognosis :
- Depends on the underlying cause
- With primary hypothyroidism the prognosis is excellent
- Prognosis of tumors on whether they are benign or malignant
- In cases with neurological involvement , the prognosis depends on the present neurological deficit.
- Children with CAH , tend to be short adults .
dr. Hisham Al-Inany Lecturer in Obstetrics and Gynecology Department, Cairo University, Egypt Dr. Amr Hussein Lecturer in Obstetrics and Gynecology Department, Cairo University, Egypt