Q. What treatment modalities are available ?
A. Treatment varies with the underlying cause.GnRH agonists, Medroxyprogesterone Acetate (MPA) and Cyproterone Acetate (CPA) are used for gonadotropin dependent CPP.

GnRH independent sexual precocity in the females (e.g. ovarian cysts) is usually treated with MPA, or occasionally with testolactone. In boys CAH is the usual cause of peripheral sexual precocity and is treated with corticosteroids. Testotoxicosis is a rare condition treated with ketoconazole, spironolactone and flutamide.

The normal variation of pubertal development such as a premature thelarche, premature isolated menarche and premature adrenarche are benign and self limited conditions requiring careful follow up without institution of therapy. Surgery, radiation, or chemotherapy are required for CNS tumor. Occasionally pedunculated hamartomas have been extirpated.

The unusual syndrome of sexual precocity associated with juvenile hypothyroidism is reversible with the institution of the thyroid therapy.

In peripheral incomplete forms of sexual precocity, GnRH-A is ineffective. Testolactone a competitive inhibitor of the enzyme aromatase which converts androgens to estrogens has been used in gonadotropin- independent McCune Albright Syndrome. MPA has been useful in the treatment of recurrent ovarian cysts, McCune Albright Syndrome and familial testotoxicosis. If TPP supervenes before/after treatment of PPP, GnRH-(A) therapy may be added.

Q. How effective are other forms of treatment in C.P.P. ?
A. Medroxy progesterone acetate (MPA) has been administered I.M. in doses varying from 50 to 400mg per month (initially 100mg/m² ) or daily orally as 5mg twice to four times a day. It is available freely, is more economical and is effective in controlling menses and secondary sex characters. Cyproterone acetate(CA) has been used in doses varying from 100 to 150 mg/m² /day in 2-3 divided doses. Both MPA and CA can suppress gonadotropin secretion in addition CA has an antiandrogenic effect. Both these drugs have very little effect on linear growth or skeletal maturation, which continues to progress.

Q. Can normal pubertal development resume when GnRH treatment is discontinued? Any other problems related to treatment ?
A. Within 6 to 18 months of discontinuation of treatment, normal pubertal development is resumed. Long term use may decrease the bone mass density as skeletal calcification may be affected to some extent. Occasionally polycystic Ovarian Syndrome (PCOS) is described.

Also available by the same author a book on Pediatric endocrinology.
"Pediatric Endocrine Disorders"

Editors:
Dr Meena P Desai
Dr Vijayalakshmi Bhatia
Dr P S N Menon

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