Central precocious puberty

Extreme clinical examples of androgen excess include central precocious puberty, the adrenogenital syndromes, and androgen-secreting adrenal, ovarian, or testicular tumors. Less severe problems include idiopathic hirsutism, premenstrual syndrome, and severe cystic acne. 

Indications Management of endometriosis and treatment of central precocious puberty... 

Dosage form Two versions of Synarel are available Synarel Nasal Solution for Central Precocious Puberty and Synarel Nasal Solution for Endometriosis. They appear to be the same except for package and labeling. Each 0.5 ounce bottle contains 8 ml Synarel Nasal Solution 2mg/ml (as nafarelin base). Each bottle is supplied with a metered spray pump that delivers 200 pg of nafarelin per spray. 

B. Indications and use Lupron Injection, Lupron Depot, Lupron Depot-3 Month, and Lupron Depot-4 Month are indicated in the palliative treatment of advanced prostate cancer. These products offer an alternative treatment when orchiectomy or estrogen administration is either not indicated or unacceptable to the patient. Lupron Injection Pediatric and Lupron Depot-PED are indicated in the treatment of children with central precocious puberty. Lupron Depot and Lupron Depot-3 Month are indicated for the management of endometriosis, including pain relief and reduction of endometriotic lesions. 

Recommended dosage and monitoring requirements According to Micromedex, the effective doses of Lupron in prostate cancer are 1 mg subcutaneously daily, or in the depot formulation 7.5 mg intramuscularly (IM) monthly, 11.25 mg every 3 months, or 30 mg every 4 months. Lupron Depot-3 month 22.5 mg is used in the treatment of advanced prostate cancer. In endometriosis, the effective dose is 3.75mg depot IM monthly or 11.25mg every 3 months for 6 months. In central precocious puberty, the recommended starting dose of Lupron Injection Pediatric is 50pg/kg... 

G. Other applications Limited data show some beneficial effects of leuprolide in the treatment of breast cancer. According to Micromedex, there is good documentation that leuprolide is effective for bowel pain and nausea associated with irritable bowel syndrome. Leuprolide has been used for controlled ovarian hyperstimulation to enhance the in vitro fertilization-embryo transfer procedure. In endometriosis, the goal of treatment is pain relief and reduction of endometriotic lesions. In children with central precocious puberty, stimulated and basal gonadotropins are reduced to prepubertal levels. Testosterone and estradiol are reduced to prepubertal levels in males and females, respectively. 

Management of endometriosis or treatment of central precocious puberty (CPP) (gonadotropin-dependent precocious puberty) in children of both sexes... 

Treatment can be carried out with injections of leuprolide or nasal application of nafarelin. Leuprolide treatment is usually initiated at a dosage of 0.05 mg/kg body weight injected subcutaneously daily and then adjusted on the basis of the clinical response. Pediatric depot preparations of leuprolide are also available. The recommended initial dosage of nafarelin for central precocious puberty is 1.6 mg/d. This is achieved with two-unit dose sprays (each spray contains 0.1 mL, 0.2 mg) into each nostril twice daily. Treatment with a GnRH agonist is generally continued to age 11 in females and age 12 in males. 

Leuprolide Agonist of GnRH receptors Increased LH and FSH secretion with intermittent administration reduced LH and FSH secretion with prolonged continuous administration Ovarian suppression, controlled ovarian hyperstimulation, central precocious puberty advanced prostate cancer Administered IV, SC, IM or intranasally depot formulations are available Toxicity Headache, lightheadedness, nausea, injection site reactions t symptoms of hypogonadism with continuous treatment... 

Minagawa K, Sueoka H. [Seizure exacerbation by the use of leuprorelin acetate for treatment of central precocious puberty in a female patient with symptomatic localization-related epilepsy. ]No To Hattatsu 1999 31(5) 466-8. 

Tanaka T, Niimi H, Matsuo N, Fujieda K, Tachibana K, Ohyama K, Satoh M, Kugu K. Results of long-term followup after treatment of central precocious puberty with leuprorelin acetate evaluation of effectiveness of treatment and recovery of gonadal function. The TAP-144-SR Japanese study group on central precocious puberty. J Clin Endocrinol Metab 2005 90 1371-6. 

Unal O, Berberoglu M, Evliyaoglu O, Adiyaman P, Aycan Z, Ocal G. Effects of bone mineral density of gonadotropin releasing hormone analogs used in the treatment of central precocious puberty. J Pediatr Endocrinol Metab 2003 16 407-11. 

H5. Heger, S., Partsch, C. J., and Sippell, W. G., Long-term outcome after depot gonadotropinreleasing hormone agonist treatment of central precocious puberty Final height, body proportions, body composition, bone mineral density, and reproductive function. J. Clin. Endocrinol. Metab. 84, 4583-4590 (1999). 

Neely, E.K. Hintz, R.L. Parker, B. Bachrach, L.K. Cohen, P. Olney, R. Wilson, D.M. Two-year results of treatment with depot leuprolide acetate for central precocious puberty. J. Pediatr. 1992, 121 (4), 634—640. 

Precocious puberty is classified as GuRH dependent or independent. GnRH-dependent precocious puberty (also called central precocious puberty) is due to precocious activation of the hypothalamic-pituitary-gonadal axis. In girls, the cause is most commonly idiopathic (90%) however, idiopathic cases account for less than 10% of central precocious puberty in boys. Central nervous systeni tumors can also cause central precocious puberty, the most common being hypothalamic hamartomas. Neurofibromatosis has been also reported to lead to GnRH-dependent precocious puberty. 

Eckert KL, Wilson DM, Bachrach LK, Anhalt H, Habiby RL, Olney RC, et al. A single-sample, subcutaneous gonadotropin-releasing hormone test for central precocious puberty. Pediatrics 1996 97 ... 

Lawson ML, Cohen N. A single sample subcutaneous luteinizing hormone (LH)-releasing hormone (LHRH) stimulation test for monitoring LH suppression in children with central precocious puberty receiving LHRH agonists. J Clin Endocrinol Metab 1999 84 4536-40. 

Lee PA. Central precocious puberty. An overview of diagnosis, treatment, and outcome. Endocrinol Metab Clin North Am 1999 28 901-18, xi. 

Partsch CJ, SippeU WG. Treatment of central precocious puberty. Best Pract Res Clin Endocrinol Metab 2002 16 165-89. 

Salerno M, Di Maio S, Gasparini N, Mariano A, Macchia V, Tenore A. Central precocious puberty A single blood sample after gonadotropin-releasing hormone agonist administration in monitoring treatment. Horm Res 1998 50 205-11. 

Advanced pro static carcinoma, endrometriosis, central precocious puberty, uterine leiomyomata Advanced prostate cancer... 

Nafarelin acetate also is used in children, male and female, for the treatment of central precocious puberty. By suppressing the release of LH, the estradiol or testosterone levels fall to prepubertal levels early secondary sexual development is arrested, linear growth and skeletal maturation are slowed, and in girls, menstruation stops. 

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