An 8-year-old girl presents with breast development (Tanner stage 2) for the past 3 months. No pubic hair. Height velocity is increased at 7 cm/year. Bone age is 11 years. GnRH stimulation test shows LH peak >5 IU/L with LH:FSH ratio >1. The diagnosis is central precocious puberty (CPP). The RECOMMENDED treatment to preserve adult height in this child is:
- A Aromatase inhibitor (letrozole) to delay bone maturation
- B Medroxyprogesterone acetate to suppress gonadotropins
- C GnRH agonist (leuprolide acetate) depot injection monthly ✓
- D Cyproterone acetate as anti-androgen therapy
Explanation
Central precocious puberty (CPP) is caused by premature activation of the hypothalamo-pituitary-gonadal (HPG) axis. GnRH agonists (GnRHa) like leuprolide acetate work by continuous (non-pulsatile) GnRH receptor stimulation, causing downregulation and desensitization of pituitary GnRH receptors, thereby suppressing LH, FSH, and sex steroid secretion. This halts pubertal progression and slows bone maturation, preserving adult height potential. Treatment is continued until an appropriate age (~11 years for girls). Aromatase inhibitors are used in peripheral precocity. Medroxyprogesterone suppresses gonadotropins partially but is inferior. Cyproterone is used in gonadotropin-independent precocious puberty.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.