A 12-year-old girl presents with breast development (Tanner stage 3), pubic and axillary hair, and regular menstruation starting at age 10. Height is on the 90th centile currently but predicted adult height is significantly below her mid-parental height. GnRH stimulation test shows LH peak >10 IU/L. The MOST appropriate treatment to optimize final adult height is:
- A GnRH analogue (triptorelin or leuprorelin) depot injection monthly ✓
- B Cyproterone acetate to block androgen action
- C Growth hormone supplementation at 0.3 mg/kg/week
- D Observation; treatment not indicated as puberty is not markedly early
Correct answer: A. GnRH analogue (triptorelin or leuprorelin) depot injection monthly
Explanation
This is central precocious puberty (CPP) in a girl with GnRH-dependent activation (LH peak >5–8 IU/L on GnRH stimulation). Treatment with GnRH agonists (depot triptorelin or leuprorelin) causes pituitary GnRH receptor downregulation, suppressing gonadotropin release and arresting pubertal progression. This allows the accelerated bone age to slow, preserving epiphyseal growth potential and improving predicted adult height. Treatment is particularly indicated when onset is before age 6 (girls) or when bone age advancement threatens final height.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.