Abstract 153: A single centre experience of gonadotropin dependent precocious puberty from Western India

Background: Gonadotropin-dependent precocious puberty (GDPP) is the most common cause of precocious puberty. Data on GDPP from Indian subcontinent is scarce. Objectives: We aim to describe single centre experience of patients with GDPP. Methods: The clinical, biochemical features and therapeutic outcomes of patients presenting with diagnosis of GDPP from Jan 2000 to July 2021 were analyzed. Results: 78 patients (girls, n = 61, 78.2%) with GDPP were included. The median age of pubertal onset (29 vs. 75 months) and age at presentation (58 vs. 82 months) was earlier in boys than in girls. The commonest presenting symptom was genitalia growth (76.47%) in boys and breast development (75.4%) in females, followed by height spurt (boys: 17.6%, girls: 11.4%), pubic hair development (boys: 5.8%, girls: 6.5%) and vaginal bleeding (6.5%). The height at presentation and target height SDS were 1.02 and -0.77 in males and 0.75 and -0.82 in females, respectively. In boys, median (range) basal serum FSH, LH and testosterone were 2.48 mIU/ml (0.42-5.7), 2.6 mIU/ml (0.52-10.01), and 3.75 ng/ml (0.1-8.27) respectively. In girls, the median (range) basal serum FSH and LH were 5.24 mIU/ml (1.03-19.8) and 2.2 mIU/ml (0.05-15.8); basal serum LH being <0.3 mIU/ml was seen in 11 females. The median post gonadotropin stimulated peak serum LH in the latter 11 females (age range: 82-99 months) was 9.37 mIU/ml (range: 5.42-19 mIU/ml). At 60 minutes, all except one patient reached a stimulated serum LH value of 3 5 mIU/ml. The median (range) difference in bone age and chronological age was 33 months (-2.0 to 98) and 2.5 months (4.0 to 76) in boys and girls, respectively. Ultrasonogram pelvis was available for 38 females. Uterine length 3 3.2 cm was found in 84.2% of patients. In boys, precocity-related MRI brain abnormality was seen in 80% whereas it was found in 23.6% of girls. Fifty-five patients were treated with injection leuprolide acetate depot [monthly 3.75 mg per (n = 2) or 7.5 mg (n = 1), three monthly 11.25 mg (n = 27) or 22.5 mg (n = 25)] whereas five patients were treated with triptorelin. Only one girl had an allergic reaction to leuprolide and was switched to triptorelin. In males, final height SDS was 0.16 (n = 2); in females, final height SDS was -0.25 (n = 20). MPH SDS in treated patients were -0.38 and -0.86 in boys and girls, respectively. Conclusion: GDPP was more common in girls. Post gonadotropin stimulated peak serum LH 35 mIU/ml at60 min aids in diagnosis in those with LH £0.3 mIU/ml. GnRH therapy helps in reducing height loss.