Adrenarche in patients with central precocious puberty: Influence on growth parameters before and during GnRH-Analog therapy

Objective: the aims of this study were to evaluate the relationship between adrenarche and central precocious puberty (CPP) and the influence of the adrenarche upon skeletal maturation and growth parameters of patients with CPP during GnRH-A therapy. Patients and methods: 40 patients (37 F, 3M) with CPP were studied before and during 2-4 years of GnRH-A therapy. Mean age at onset of CPP and at the start of GnRH-A therapy were 6.35±1.78 yrs and 7.7±1.6 yrs, respectively. The plasma DHEA-S levels at a concentration > 0.60 mcg/ml were used as a hormonal marker of adrenarche. Results: Before GnRH-A therapy 30 out of 40 patients aged 7.33±1.7 yrs had a preadrenarcheal DHEA-S levels that were similar to those of prepubertal age-matched controls, the remaining 10 patients older than 7 yrs (8.27±0.84 yrs) showed adrenarcheal DHEA-S levels that were similar to those of normal pubertal children. Before therapy the adrenarcheal children didn’t show significant differences in growth parameters and bone age (BA) compared with preadrenarcheal patients, in the former the BMI SDS tended to be higher than in the latter but not significantly (1.92±1.84 vs 1.35±1.81). During gonadal suppression, the improvement in predicted adult height and in CA /BA ratio induced by GnRH-A therapy was not significantly different in adrenarcheal and preadrenarcheal patients. Conclusion: The results of this study show that adrenarche was present only in patients with onset of CPP after 7 years of age. This finding may suggest that the onset of CPP was independent of activation of adrenal androgens in young patients. The adrenarcheal children didn‘t show growth parameters and bone age maturation different from those without adrenarche. Moreover, the increased adrenal DHEA-S production at the diagnosis of CPP didn‘t restrain the beneficial effects of GnRH-A therapy on bone age and predicted adult height of our CPP patients.