Treatment of Children With Central Precocious Puberty: 3 Years of Continuous Suppression With Histrelin Subdermal Implants

BACKGROUND Central precocious puberty (CPP) in girls seriously affects their physical and mental development in childhood. The method of diagnosis—gonadotropin-releasing hormone (GnRH)–stimulation test or GnRH analogue (GnRHa)–stimulation test—is expensive and makes patients uncomfortable due to the need for repeated blood sampling. OBJECTIVE We aimed to combine multiple CPP–related features and construct machine learning models to predict response to the GnRHa-stimulation test. METHODS In this retrospective study, we analyzed clinical and laboratory data of 1757 girls who underwent a GnRHa test in order to develop XGBoost and random forest classifiers for prediction of response to the GnRHa test. The local interpretable model-agnostic explanations (LIME) algorithm was used with the black-box classifiers to increase their interpretability. We measured sensitivity, specificity, and area under receiver operating characteristic (AUC) of the models. RESULTS Both the XGBoost and random forest models achieved good performance in distinguishing between positive and negative responses, with the AUC ranging from 0.88 to 0.90, sensitivity ranging from 77.91% to 77.94%, and specificity ranging from 84.32% to 87.66%. Basal serum luteinizing hormone, follicle-stimulating hormone, and insulin-like growth factor-I levels were found to be the three most important factors. In the interpretable models of LIME, the abovementioned variables made high contributions to the prediction probability. CONCLUSIONS The prediction models we developed can help diagnose CPP and may be used as a prescreening tool before the GnRHa-stimulation test.

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Clinical characteristics and treatment patterns with histrelin acetate subcutaneous implants vs. leuprolide injections in children with precocious puberty: a real-world study using a US claims database

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0721 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Lawrence A. Silverman ◽

Xu Han ◽

Huan Huang ◽

Aimee M. Near ◽

Yiqun Hu

Keyword(s):

Precocious Puberty ◽

Central Precocious Puberty ◽

Treatment Costs ◽

Interquartile Range ◽

Duration Of Treatment ◽

Claims Database ◽

Total Treatment ◽

Patient Groups ◽

Hormone Analogs ◽

Index Treatment

Abstract Objectives Gonadotropin-releasing hormone analogs are the treatment of choice for central precocious puberty (CPP). This study characterizes patients treated with histrelin implant or leuprolide injection. Methods A US claims database was used to identify patients aged ≤20 years with ≥1 histrelin or leuprolide claim (index treatment) between April 2010 and November 2017 and continuous enrollment ≥3 months before and ≥12 months after the index treatment date. Results Overall, 4,217 patients (histrelin, n=1,001; leuprolide, n=3,216) were identified. The percentage of patients with CPP diagnosis was greater in the histrelin (96.5%) vs. leuprolide (68.8%; p<0.0001) cohort. In patients with CPP (histrelin, n=966; leuprolide, n=2,214), mean age at treatment initiation was similar for histrelin (9.0 ± 2.0 years) and leuprolide (9.1 ± 2.3 years), with >50% of patients aged 6–9 years. Mean treatment duration was significantly longer for histrelin (26.7 ± 14.8 months) vs. leuprolide (14.1 ± 12.1 months; p<0.0001), and was longer in younger patient groups. More patients switched from leuprolide to histrelin (12.3%) than vice versa (3.6%; p<0.0001). Median annual total treatment costs were slightly lower for the histrelin cohort ($23,071 [interquartile range, $16,833–$31,050]) than the leuprolide cohort ($27,021 [interquartile range, $18,314–$34,995]; p<0.0001). Conclusions Patients with CPP treated with histrelin had a longer duration of treatment, lower rates of index treatment discontinuation, and lower annual treatment costs vs. those treated with leuprolide.

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Central precocious puberty in a girl with LEGIUS syndrome: an accidental association?

Italian Journal of Pediatrics ◽

10.1186/s13052-021-01004-9 ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Valentina Orlandi ◽

Paolo Cavarzere ◽

Laura Palma ◽

Rossella Gaudino ◽

Franco Antoniazzi

Keyword(s):

Genetic Analysis ◽

Precocious Puberty ◽

Central Precocious Puberty ◽

Neurofibromatosis Type ◽

Case Presentation ◽

New Variant ◽

Legius Syndrome ◽

Timing Of Puberty ◽

First Time

Abstract Background Central precocious puberty is a condition characterized by precocious activation of the hypothalamic-pituitary-gonadal axis. It may be idiopathic or secondary to organic causes, including syndromes such as Neurofibromatosis type 1 (NF1). Case presentation We presented a girl of 6 years and 10 months with almost 11 café-au-lait skin macules, without other clinical or radiological signs typical of NF1, and with a central precocious puberty. Genetic analysis evidenced the new variant NM-152594.2:c.304delAp. (Thr102Argfs*19) in SPRED1 gene, which allowed to diagnose Legius syndrome. Conclusions We report for the first time a case of central precocious puberty in a girl with Legius syndrome. The presence of central precocious puberty in a child with characteristic café-au-lait macules should suggest pediatricians to perform genetic analysis in order to reach a definitive diagnosis. Further studies on timing of puberty in patients with RASopathies are needed to better elucidate if this clinical association is casual or secondary to their clinical condition.

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Psychiatric disorders, peer-victimization, and quality of life in girls with central precocious puberty

Journal of Psychosomatic Research ◽

10.1016/j.jpsychores.2021.110401 ◽

2021 ◽

Vol 143 ◽

pp. 110401

Author(s):

Özge Gizli Çoban ◽

Aynur Bedel ◽

Arif Önder ◽

Aslı Sürer Adanır ◽

Hale Tuhan ◽

...

Keyword(s):

Quality Of Life ◽

Psychiatric Disorders ◽

Peer Victimization ◽

Precocious Puberty ◽

Central Precocious Puberty

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Rapid progressive central precocious puberty: diagnostic and predictive value of basal sex hormone levels and pelvic ultrasound

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0577 ◽

2020 ◽

Vol 33 (6) ◽

pp. 785-791

Author(s):

Valeria Calcaterra ◽

Catherine Klersy ◽

Federica Vinci ◽

Corrado Regalbuto ◽

Giulia Dobbiani ◽

...

Keyword(s):

Precocious Puberty ◽

Tanner Stage ◽

Central Precocious Puberty ◽

Bone Age ◽

Diagnostic Value ◽

Sex Hormone ◽

Pelvic Ultrasound ◽

Predictive Values ◽

Hormone Levels ◽

Ultrasound Parameters

AbstractObjectivesData on the predictive values of parameters included in the diagnostic work-up for precocious puberty (PP) remain limited. We detected the diagnostic value of basal sex hormone levels, pelvic ultrasound parameters and bone age assessment for activation of the hypothalamic-pituitary-gonadal axis in girls with PP, in order to help in the decision to perform GnRH testing.Patients and methodsWe retrospectively considered 177 girls with PP. According to puberty evolution, the girls were divided into two groups: rapid progressive central precocious puberty (RP-CPP) and non/slowly progressive/transient forms (SP-PP). In all patients we considered Tanner stage, basal luteinizing hormone (LH) and estradiol (E2) values, bone age, and pelvis examination. We assessed the diagnostic value of each variable and identified the number of pathological parameters that best identify patients with RP-CPP.ResultsBasal LH ≥ 0.2IU/L, E2 level ≥ 50 pmol/L, uterine longitudinal diameter ≥ 3.5 cm, transverse uterine diameter ≥ 1.5 cm, endometrial echo and ovarian volume ≥ 2 cm3 were significantly associated with RP-CPP (p ≤ 0.01). The ability to diagnose RP-CPP was enhanced with increasing number of pathological hormonal and instrumental parameters (p < 0.001). With more than three parameters detected, sensitivity and specificity reached 58% (95%CI 48–67) and 85% (95%CI 74–92), respectively, with a PPV = 86% (95%CI 76–93) and PPN = 54% (95%CI 43–54); the area under the ROC curve was 0.71 (95%CI 0.65–0.78).ConclusionDespite the availability of different tests, diagnosing RP-CPP remains difficult. A diagnosis model including at least three hormonal and/or ultrasound parameters may serve as a useful preliminary step in selecting patients who require GnRH testing for early detection of RC-PP.

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Short-term effects of gonadotropin-releasing hormone analogue treatment on leptin, ghrelin and peptide YY in girls with central precocious puberty

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2020-0470 ◽

2021 ◽

Vol 34 (4) ◽

pp. 479-484

Author(s):

Piyathida Wijarn ◽

Preamrudee Poomthavorn ◽

Patcharin Khlairit ◽

Sarunyu Pongratanakul ◽

Laor Chailurkit ◽

...

Keyword(s):

Precocious Puberty ◽

Peptide Yy ◽

Central Precocious Puberty ◽

Gonadotropin Releasing Hormone ◽

Hormone Analogue ◽

Short Term ◽

Serum Leptin ◽

Releasing Hormone ◽

Gonadotropin Releasing Hormone Analogue ◽

Before And After

Abstract Objectives To determine appetite-regulating hormone levels in girls with central precocious puberty (CPP) before and after 20 weeks of gonadotropin-releasing hormone analogue (GnRH-A) treatment. Methods Eighteen newly diagnosed CPP girls were enrolled. Body composition measured by bioelectrical impedance analysis and GnRH-A test were performed with fasting serum leptin, ghrelin and peptide YY (PYY) measurements at baseline (before) and after 20 weeks of GnRH-A treatment. Results Following GnRH-A treatment, all patients had prepubertal gonadotropin and estradiol levels. Mean (SD) fat mass index (FMI) was significantly increased from 4.5 (1.7) to 5.0 (1.8) kg/m2 after treatment. Also, median (IQR) serum leptin level was significantly increased from 6.9 (4.2–8.6) to 7.4 (5.3–13.1) ng/mL. FMI had a positive correlation with serum leptin level (r=0.64, p=0.004). In contrast, no significant changes of serum ghrelin and PYY levels were observed. Conclusions Decreased estrogen following short-term GnRH-A treatment in CPP girls may cause an increase in appetite and consequently an elevation of FMI. Increased serum leptin may be a result of having increased FMI secondary to an increase in appetite.

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