آیا همه بیماران مبتلا به بلوغ زود رس باید درمان شوند؟

بلوغ زودرس مرکزی در دختران بطور شایع رخ می‌دهد. از طرف دیگر درمان بلوغ زودرس مرکزی با آگونیست‌های هورمون‌های آزادکننده گنادوتروپین‌ها (gnrh) بطور وسیع مورد استفاده قرار  می‌گیرد. آگونیست‌های gnrh با مهار محور هیپوتالاموس -هیپوفیز- گناد، سبب توقف صفات ثانویه جنسی و پیشگیری از پیشرفت سن استخوانی و در نتیجه حفظ پتانسیل رشد قدی بیماران می‌شود. با استفاده روز افزون از آگونیست‌های gnrh، این امرمهم باید روشن شود که چه گروهی از بیماران مبتلا به بلوغ زودرس مرکزی از این درمان سود می‌برند. فاکتورهای مهم در انتخاب بیماران جهت درمان فوق عبارتند از: سن شروع بلوغ، سرعت پیشرفت بلوغ و قد نهایی پیش‌بینی‌شده. هر چه سن شروع بلوغ پایین‌تر باشد (کمتر از 6 سالگی در دختران)، سرعت پیشرفت علائم بلوغ بیشتر باشد (تغییر از یک مرحله بلوغ به مرحله دیگر در مدت کمتراز 63 ماه) و هر چه قد نهایی پیش‌بینی‌شده بیماران کمتر باشد (در دختران کمتر از 150 سانتیمتر و در پسران کمتر از 160 سانتیمتر) این بیماران از درمان با آگونیست‌های gnrh سود بیشتری می‌برند. 

whether all patients with central precocious puberty should be treated?

precocious puberty is the appearance of secondary sexual characteristics before 8 years old in girls and 9 years old in boys. precocious puberty is divided into 3 groups of central, peripheral and normal variants. central precocious puberty is accompanied by activation of hypothalamicpituitarygonadal axis which causes increase in secretion of gonadotropin releasing hormone(gnrh) and in turn increase in secretion of gonadotropins (lh and fsh) from pituitary and consequently increase in secretion of sexual steroids (estrogen or testosterone) from gonads. this results in premature closure of growth plates and shorter final height.  gnrh agonists via suppression of hypothalamicpituitarygonadal axis, causes decrease sex steroid production, prevention of bone age advancement and ultimately result in increasing final height  in patients. central precocious puberty is the most common type of precocious puberty, which has a higher prevalence in girls.  use of gnrh agonists is the best treatment for central precocious puberty.this article reviews important factors affecting selection of patients with central precocious puberty, to be treated by gnrh agonists.purposes of treatment with gnrh agonist: the main objective of treating patients with central precocious puberty is to prevent  premature closure of growth plates and providing enough time for height growth to ensure normal final height.  the other purpose of treatment of these patients is to lower their psychosocial stress, emanating from precocious beginning of pubertal signs in these children and their families. stoppage of menarche in patients with mental retardation or cerebral paralysis that are not able to manage their menarche. the level of increase in final height after treatment with gnrh agonists on patients with precocious puberty varies.factors affecting final height of patients with central precocious puberty after treatment with gnrh agonists: pubertal beginning age: the sooner commencement of pubertal age happens, the shorter final height will be. advancement of bone age: this factor, at the commencement phase of treatment and its termination, is accompanied by shorter final height. this indicates that if treatment is delayed to after a specific bone age (advanced), then reviving the entire potential of final height is not feasible. kauli and his colleagues indicated that if treatment starts prior to advancement of bone age to 12 years old, it would be more useful. height standard deviation score (sds): higher sds of patients height at the beginning or end of treatment, results in higher final height. target height: if target age is taller, then final height increases.main factors for selecting patients with central precocious puberty, for their treatment with gnrh agonists: age of patients at the beginning of pubertal signs: in patients with central precocious puberty, the lower is their age, the faster progresses their pubertal signs and bone age. this causes premature closure of growth plates and shorter final height. rate of sexual maturation: patients with central precocious puberty, in terms of advancement of their pubertal signs, are divided into two groups of rapidly progressive and slowly progressive. in the latter group, pubertal signs and bone age progresses rapidly and this leads to shorter final height. predicted adult height: the most common way of calculating predicted adult height is bayleypinneau. in this method, final height is calculated on the basis of percentage of current height, bone age and relation between bone age and calendar age. patients with precocious puberty, with lower predicted adult height, will have shorter final height. other factors that are needed to be taken into account in treatment of central precocious puberty are: family background of precocious puberty; small for gestational age and adapted child.