Carcinoma corticosuprarrenal virilizante en un niño / Virilizing adrenocortical carcinoma in a child

Introducción: Los tumores suprarrenales en niños son poco frecuentes y el carcinoma suprarrenal representa menos de un 10 %. En el prepúber, la manifestación más típica es el desarrollo de pubertad precoz. Objetivo: Describir las características clínicas, los procederes diagnósticos y terapéuticos de un paciente con carcinoma adrenal en edad pediátrica. Presentación de caso: Paciente de 8 años, masculino y de piel blanca con antecedentes de salud. Acude a la consulta por crecimiento de vello pubiano y aumento del pene en longitud y grosor de aproximadamente 2 años de evolución. En el examen físico se constatan aumento de la velocidad de crecimiento y signos sugestivos de virilización (voz gruesa, vello axilar, vello sexual púbico y genitales externos estadio III de Tanner). Se realizaron estudios hormonales que corroboraron el hiperandrogenismo por secreción endógena autónoma, con niveles de gonadotropinas suprimidas, niveles de testosterona y dehidroepiandrosterona elevados. También se realizaron estudios imagenológicos que evidenciaron edad ósea acelerada y la existencia de un tumor. Se realizó una adrenalectomía izquierda y se confirmó por anatomía patológica el carcinoma corticosuprarrenal virilizante izquierdo en estadío 2. Inició un tratamiento con quimioterapia por dicho diagnóstico y actualmente se mantiene en seguimiento. Conclusiones: Los carcinomas corticosuprarrenales en niños son mayoritariamente funcionantes y constituyen una de las causas de pubertad precoz periférica. Estos son infrecuentes y agresivos, por lo que la realización de estudios genéticos en familias con síndromes hereditarios contribuiría a su diagnóstico precoz para un adecuado tratamiento y mejor pronóstico(AU)

Introduction: Adrenal tumors in children are rare and adrenal carcinoma represents less than the 10 percent. In the prepubescent, the most typical manifestation is the development of early puberty. Objective: Describe the clinical characteristics and diagnostic and therapeutic procedures of a patient with adrenal carcinoma in a pediatric age. Case presentation: 8-year-old male, white-skinned patient with a history of health conditions. He attentds to the consultation due to pubic hair growth and penis enlargement in length and thickness of approximately 2 years of evolution. Physical examination shows increased growth rate and signs suggestive to virilization (deep voice, axillary hair, pubic sexual hair and external genitalia in Tanner's stage III). Hormonal studies were carried out that corroborated hyperandrogenism by autonomic endogenous secretion, with suppressed gonadotropin levels, elevated testosterone and dehydroepiandrosterone levels. Imaging studies were also performed that showed accelerated bone age and the existence of a tumor. A left adrenalectomy was performed and stage 2 left virilizing adrenocrotical carcinoma was confirmed by pathological anatomy studies. He began chemotherapy treatment for this diagnosis and is currently being followed up. Conclusions: Adrenocortical carcinomas in children are mostly functioning and are one of the causes of peripheral early puberty. These are uncommon and aggressive, so genetic studies in families with hereditary syndromes would contribute to their early diagnosis for adequate treatment and better prognosis(AU)

Obesity and women health: from womb to tomb

Obesity is a highly prevalent disease reaching epidemic proportions these days in India. Obesity affects all human beings especially women affecting their health drastically. It affects each phase of their life in serious manner. We present here the spectrum of diseases that obesity can cause to a women during her entire life.

Síndrome de Van Wyk-Grumbach / Van Wyk-Grumbach syndrome

RESUMEN El síndrome de Van Wyk-Grumbach se caracteriza por hipotiroidismo primario de larga duración asociado a pubertad precoz. Se presenta una paciente de 7 años, mestiza, que acude por sangrado vaginal, acompañado de hiperpigmentación de las areolas sin galactorrea, abdomen globuloso, mixedema, hirsutismo, baja talla, astenia y retraso escolar. La química sanguínea mostró anemia, hipercolesterolemia y hipertransaminasemia; los estudios de imágenes constataron derrame pericárdico, retraso marcado de la edad ósea, incremento de las dimensiones de la silla turca y gran quiste del ovario con aparente criterio quirúrgico. Los estudios hormonales confirmaron la sospecha de hipotiroidismo primario asociado a hiperprolactinemia. El tratamiento sustitutivo con levotiroxina sódica revirtió los signos y síntomas de pubertad precoz, lo que evitó la cirugía del quiste de ovario; la recuperación en el ambiente escolar y social fue indiscutible. Reconocer esta entidad evita tratamientos absolutamente contraindicados, como la extirpación de los quistes o el tratamiento quirúrgico de la hiperplasia hipofisaria(AU)

ABSTRACT Van Wyk-Grumbach syndrome is characterized by long-lasting primary hypothyroidism associated with precocious puberty. A case of a 7-year-old female mestizo patient is reported. She came to consultation for vaginal bleeding, accompanied by hyperpigmentation of the areolas without galactorrhea, globular abdomen, myxedema, hirsutism, short stature, asthenia and school delay. Blood chemistry showed anemia, hypercholesterolemia and hypertransaminasemia. Imaging studies showed pericardial effusion, marked delay in bone age, increased dimensions of Turkish chair and large ovarian cyst with apparent surgical criteria. Hormonal studies confirmed the suspicion of primary hypothyroidism associated with hyperprolactinemia. Substitute treatment with levothyroxine sodium reversed the signs and symptoms of precocious puberty, which prevented ovarian cyst surgery; the recovery in the school and social environment was certain. Recognizing this entity avoids absolutely contraindicated treatments, such as the removal of cysts or the surgical treatment of pituitary hyperplasia(AU)

Función gonadal en niños y adolescentes nacidos con restricción del crecimiento intrauterino / Gonadal function in children and adolescents born with restriction of intrauterine growth

Los niños con restricción del crecimiento intrauterino (RCIU) presentan en la vida posnatal una serie de alteraciones metabólicas y hormonales, y tienen predisposición al desarrollo de obesidad, hipertensión arterial, enfermedad cardiovascular, resistencia a la insulina y diabetes tipo 2. La exposición a un ambiente intrauterino desfavorable en fases críticas del desarrollo puede tener un efecto deletéreo sobre la gónada en formación. Se realizó una revisión bibliográfica y puesta al día sobre la posible asociación entre RCIU y alteraciones de la función gonadal en niños y adolescentes de ambos sexos. Para facilitar la actualización, se dividió por etapas en: 1, prenatal; 2, posnatal y prepuberal; 3, puberal, y 4, adulta. La mayoría de los niños que nacen muy prematuros o con muy bajo peso al nacer hacen una transición sin obstáculos desde la infancia a la edad adulta con respecto a la salud reproductiva. Sin embargo, en los varones se puede observar criptorquidia, hipospadias, cáncer testicular y menor fertilidad, y en las niñas, pubertad y menarca temprana, hiperandrogenismo y síndrome de ovario poliquístico. Existen datos controvertidos y se necesitan más estudios para aclarar la relación entre el RCIU y la función hipotálamo-hipófiso-gonadal.

Low birth weight due to intrauterine growth restriction (IUGR) is associated with an increased risk of obesity, hypertension, cardiovascular disease, insulin resistance, and type 2 diabetes during postnatal life. Exposure to an unfavourable intrauterine environment in critical phases of development may have a deleterious effect on the forming gonad. The objective was to carry out a bibliographic review and update on the possible association between IUGR and alterations of gonadal function in children and adolescents of both sexes. To facilitate the update, this was divided into stages: 1, prenatal; 2, postnatal and pre-pubertal; 3, puberal, and 4, adult. Most children born preterm or with low birth weight make a normal transition from childhood to adulthood with respect to reproductive health. However, cryptorchidism, hypospadias, testicular cancer and lower fertility could be observed in boys, and early puberty and menarche, hyperandrogenism and polycystic ovarian syndrome in girls. However, the data are controversial, and further studies are needed to clarify the relationship between IUGR and pituitary gonadal function.

An investigation on the status of education and health service related to sexual and reproductive health among early adolescent students / 预防医学

Objective Toanalyzethestatusofeducationandhealthservicerelatedtosexualandreproductivehealthamong early adolescent students in Zhejiang Province and to provide scientific evidence for puberty education and health service. Methods Across-sectionalsurveywasconductedamong1312primarystudentsfromgrade4to6inZhejiangProvince, with stratified cluster sampling method.A self-made questionnaire was used to collect the information of their demographic characteristics and the utilization and demand situation of education and health service related to sexual and reproductive health.Results Amongthestudents,37.33percentofthestudentshadnevergotthesexualandreproductivehealth knowledge from school,and only 32.92 percent of them said that their school had provided adolescent health care service, and 34.32 percent of them was not satisfied with this service.And 48.75 percent of them said that their parents had never communicated SRH topics with them,meanwhile,35 .94 percent of them had never asked their parents SRH questions,and only 16.96 percent of them felt easy when they communicate SRH topics with their parents,and only 23.69 percent of them hope to communicate SRH topics with their parents.Meanwhile,59.65 percent of them had never communicated SRH topics with their peers,and 10.67 percent of them had gone to hospital due to pubertal development and reproductive health problems,and 59.41 percent of them thought it necessary to open adolescent reproductive health clinics in society. Conclusion Schooleducation,familyeducation,peereducationandsocialhealthservicerelatedtosexualand reproductive health among early adolescent students is relatively backward,and there is a big gap between the existing service and the demand of adolescents.

Gender specific associations between early puberty and behavioral and emotional characteristics in children / 中华流行病学杂志

Objective To understand the gender specific association between early puberty and behavioral and emotional characteristics in children.Methods The questionnaire survey was conducted among the girls in grade 2-3,boys in grade 3-4 and both girls and boys in grade 7-8 selected through cluster sampling in 2 middle schools and 2 primary schools in Beijing and Shenyang respectively in November 2014.The questionnaire contents included general information,physical activity and video time,pubertal development scale (PDS) and strength and difficulties questionnaire (SDQ).Descriptive statistics were used to describe the prevalence of early puberty and the detection rate of abnormal behavioral problems.The effects of early puberty on behavioral and emotional problems were estimated with univariate and multivariate logistic regression analyses.The odds ratios and their 95％ confidence intervals were calculated.Results A total of 3 253 complete questionnaires were collected,the prevalence of early puberty was 15.9％ (518).The detection rate (number) of abnormal emotional symptoms,conduct problems,hyperactivity/inattention,peer relationship problems,pro-social behaviors and total difficulties were 8.3％ (269),9.1％ (297),6.5％ (211),16.4％ (534),9.2％ (299) and 13.8％(448) respectively.Multivariate logistic regression analysis showed that early puberty was the risk factor for conduct problems (OR=2.260,95％CI:1.322-3.863) and hyperactivity/inattention (OR=1.980,95％ CI:1.111-3.527) in the girls,and early puberty was risk factor for total difficulties in boys (95％CI:1.018-2.063).Conclusions Early puberty might increase the risk of conduct problems and hyperactivity/inattention in girls and increase the risk of total difficulties in boys.It is important to conduct gender specific psychological intervention among adolescents for improving their physical and mental health.

Abordagem do pediatra na puberdade precoce (do leite de bruxa ao Tanner V) / Role of the Pediatrician in early puberty (from witch milk to Tanner V)

O autor estuda o desenvolvimento puberal normal, define a puberdade precoce, analisa suas variações epidemiológicas, classificação e doenças envolvidas, quanto ao diagnóstico e tratamento, avaliação pelo pediatra e encaminhamento ao endocrinologista, quando necessário.

Associations between adverse childhood experiences with early puberty timing and possible gender difference / 中华流行病学杂志

Objective To explore the association of adverse childhood events with early puberty timing and possible gender differences.Methods Data was gathered through questionnaires,physical and secondary sexual characteristics,examination with breast stage in girls and testicular volume in boys measured under informed consent among children in grade 3 to grade 5 from a largescale primary school.Information regarding adverse childhood experiences (ACEs),time of screening and physical activity was included in the questionnaire.Age limits on secondary sexual characteristics for defining early puberty established under the "China Puberty Research Collaboration Project" were used to classify early puberty timing.Body mass index was calculated and used to classify both overweight and obesity,in each gender.Results Among the 1 744 children aged 8.2-12.2 years old (957 boys),the prevalence rates of early puberty timing among boys and girls were 7.5％ and 14.6％,respectively,with gender differences (x2＝ 11.671,P＜ 0.001).Boys who reported having experienced serious adverse family events and girls with physical abuse were more likely to develop early puberty.Results from multivariate logistic regression analysis showed that family life events were associated with a higher risk of early puberty timing in boys (odds ratio:2.531,95％ CI:1.276-5.020) while experience related to physical abuse appeared a risk factor of early puberty timing in girls (odds ratio:2.453,95％CI:1.588-3.788).Conclusion Physical abuse and adverse family life events seemed to be associated with early puberty timing,suggesting further longitudinal study should be carried out to understand the nature of these findings and gender differences.

The progress on genes associated with early puberty / 国际儿科学杂志

Puberty onset is triggered by re-emergence of the hypothalamic-pituitary-gonadal axis (HPGA),which is characterized by the significantly increasing amplitude and frequency of gonadotropin-releasing hormone (GnRH) secretion in human being.A series of studies found that many genes control puberty onset,including KISS1 and GPR54 gene,estrogen receptor (ESR) gene,energy balance-related genes,LIN28B gene,MKRN3 gene and so on.Studies have been confirmed that the mutation and single nucleotide polymorphisms (SNP) of the genes above are associated with early puberty.In this paper,the relationship between genetic alterations of these genes and early puberty are summarized as follows.-

Ultrassonografia pélvica em crianças e adolescentes: [revisão] / Pelvic ultrasonography in children and teenagers: [review]

O conhecimento das mudanças que ocorrem no útero e ovários durante a puberdade é fundamental ao investigar alterações da pelve feminina em crianças e adolescentes. O exame ultrassonográfico nestas pacientes é rotineiramente realizado por via abdominal usando o líquido da bexiga como uma janela ultrassônica, embora possa ser algumas vezes realizado pela via vaginal em adolescentes sexualmente ativas. As principais indicações para ultrassonografia pélvica em crianças e adolescentes são a puberdade precoce ou atrasada, dor ou massas pélvicas, genitália ambígua, sangramento vaginal em crianças e amenorreia primária. Neste artigo relatamos a técnica do exame, além de descrever os achados mais freqüentes.

The knowledge of uterine and ovarian changes in the puberty is essential in the investigation changes in the female pelvis of children and teenagers. In these patients, pelvic ultrasonography is routinely performed with a full bladder to produce an acoustic window, although this examination may also be performed with endovaginal approach in sexually active teenagers. Main indications for pelvic ultrasonography in children and teenagers are either early or delayed puberty, pelvic pain or tumors, ambiguous genitalia, vaginal bleeding in children, and primary amenorrhea. In the present paper, the authors describe the scanning technique and the most frequent sonographic findings.

A comparative study of the puberty suppression effect of gonadotropin-releasing hormone agonist in precocious or early puberty girls / 소아과

PURPOSE: There has been considerable disagreement regarding the most appropriate dosage of gonadotropin-releasing hormone agonist in cases of central precocious puberty. The aim of this study was to determine the appropriate dosage for suppression of the puberty in girls with central precocious or early puberty. METHODS: Twenty-two girls with early puberty were randomly subjected to 3 types of dosages of leuprolide acetate for at least 6 months. The number of cases in groups 1, 2, and 3 were 7, 7, and 8, and dosages were 70, 90, and 110 microgram/ kg/-month, respectively. Height, weight, bone age, Tanner stage of breast development, and serum levels of LH, FSH, estradiol, and progesterone were measured before treatment and after 6 months of treatment. The number of cases of puberty suppression was compared using a modified puberty suppression score with a nonparametric chi-square test. RESULTS: There were no significant differences of chronologic and bone ages among the groups. There was a significant decrease in height SDS gain after 6 months in group 3 (P<0.05) compared with groups 1 and 2. Serum levels of LH, FSH, estradiol and progesterone were all significantly decreased after treatment in all 3 groups (P<0.05). The number of cases of puberty suppression in each group were 4 (57%), 5 (71%), and 8 (100%). There was a significantly increased proportion of suppression of puberty in group 3 (P<0.05). CONCLUSION: It was necessary to use a higher dose of gonadotropin-releasing hormone agonist to suppress early puberty in girls; however further longitudinal study will be needed for their prognosis of final adult height.

Hormônio de crescimento e bloqueio puberal: quando essa combinação pode melhorar a estatura final? / Growth hormone and puberal block: when can this combination improve final height?

Os autores discutem a conveniência, ou não, de indicar a terapêutica hormonal, consistindo no bloqueio puberal, no tratamento da puberdade precoce.

Clinical and Endocrinologic Characteristics of Children Referred for Precocious Puberty / 대한소아내분비학회지

PURPOSE: Precocious puberty is defined as the onset of secondary sexual characteristics before 8 year of age in girls and 9 year in boys. The purpose of this study is to analyze the spectrum of diagnoses made in a consecutive group of children referred for signs of precocious puberty and evaluate the clinical and endocrinologic characteristics of patients with precocious puberty. METHODS: The charts of all 948 children referred for evaluation of signs of precocious puberty between January 2003 and June 2007 in several referral centers were reviewed. Clinical features including age of onset, presenting symptoms, yearly growth rate, bone age advancement, weight, height, and body mass index were analysed and endocrine investigations included basal and gonadotropin releasing hormone (GnRH)-stimulated levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) as well as sex hormones. RESULTS: Of the 948 children referred for signs of precocious puberty, 915 (96.5%) were female and 33 (3.5%) were male. The final diagnoses made were early puberty (39%), premature thelarche (31%), true precocious puberty (27%) and precocious pseudopuberty (1%). The increases in yearly growth rate and bone age advancement were significant in true precious puberty group (P<0.05). The height and weight standard deviation score were significantly increased in true precious puberty and premature thelarche group compared to the average level according to gender and age (P<0.05). Endocrinologic studies showed that the level of basal LH, basal estradiol and GnRH-stimulated peak LH, peak FSH, peak LH/basal LH, peak FSH/basal FSH, peak LH/peak FSH ratio was all significantly higher in true precicous puberty group and early puberty group when compared to premature thelarche group (P<0.05). Neurogenic true precocious puberty among true precocious puberty was more common in boys (3 out of 7, 42.8%) than in girls (27 out of 253, 10.7%). Endocrinologic studies did not show any difference between idiopathic precocious puberty and neurogenic precocious puberty. CONCLUSION: The result of this study showed the proportion of true precocious puberty among the children referred for early pubertal signs was rather high. Collectively assessing all available data including detailed history, growth records, physical findings, laboratory studies and radiological imaging is important in the evaluation of a child with concerns of early pubertal maturation. Foregoing extensive studies regarding incidence and causes of true precocious puberty should be needed.

The Effect of Gonadotropin Releasing Hormone Agonist with or without Growth Hormone Treatment on Predicted Adult Height in Girls with Early Puberty / 대한소아내분비학회지

PURPOSE: Many recent studies have been performed to improve adult height in short normal girls with early puberty by arresting rapid pubertal progression. We evaluated the effect of combined therapy with growth hormone (GH) and gonadotropin releasing hormone agonist (GnRHa) on predicted adult height in girls with early puberty, comparing them with a group treated with GnRHa alone. METHODS: Twenty eight girls with early puberty were classified into two groups and treated for an average 18 months. Group I of 18 girls was treated with GnRHa alone (leuprolide acetate; dosage: 30-90 mcg/kg, s.c. every 28 days) and group II of 10 girls was treated in combination with GH (dosage: 0.1 IU/kg, s.c. 5-7 days/week). Two groups were compared in terms of bone age, height, sexual maturity, and predicted adult height at the start and after the treatment. RESULTS: Two groups were not significantly different from each other in chronologic age, bone age, weight, target height, and sexual maturity before and after treatment. After treatment, group I showed predicted adult height (157.1+/-6.2 cm) which was comparable to target height (157.1+/-3.7 cm) and was not significantly higher than predicted adult height before treatment (156.0+/-6.5). On the contrary, group II showed predicted adult height (158.5+/-4.6 cm) which was comparable to target height (156.2+/-3.6 cm), but significantly higher than predicted adult height before treatment (154.2+/-7.4 cm) (P<0.05). CONCLUSIONS: GH and GnRHa combination treatment is more effective than GnRHa treatment alone to improve predicted adult height in girls with early puberty.

Effect of Potent Aromatase Inhibitor (Letrozole) on Bone Maturation and Predicted Adult Height in Boys with Early Puberty / 대한소아내분비학회지

PURPOSE: We evaluated the effect of potent aromatase inhibitor (Letrozole) on the rate of bone maturation and an increase in predicted adult height (PAH) in boys with early puberty. METHODS: Nine boys, aged 10.9-12.9 years, with early puberty were studied. The boys were treated with the aromatase inhibitor, letrozole, 2.5 mg/day for 1 year. The main outcome parameters were the change in bone age and predicted adult height. Also, serum LH, FSH, testosterone and estradiol concentrations were measured and sexual maturation before and after 12 months of treatment were evaluated. RESULTS: PAH significantly increased by 3.3 cm (P<0.05) and PAH standard deviation score significantly increased by 0.6 (P<0.05). Bone age before therapy advanced by 0.72+/-0.93 year, but bone age after therapy decreased by 0.07+/-0.90 year compared to chronological age (P<0.01). Whereas, sexual maturation of the subjects progressed normally. CONCLUSION: These results suggest that treatment with the potent aromatase inhibitor, letrozole, delays bone maturation and improves PAH in boys with early puberty.

Effect of Gonadotropin Releasing Hormone Agonist on Growth and Sex Hormone in Girls with Early Puberty / 대한소아내분비학회지

PURPOSE: Gonadotropin releasing hormone agonist (GnRHa) treatment is widely used in precocious puberty to delay rapid pubertal growth and increase final height. But, girls who enter puberty 8 to 9 years also have same course with precocious puberty in many cases. Therefore GnRHa treatment is used in girls with early puberty, but the effects are controversial. We analyzed growth velocity and sex hormone concentrations in early puberty during and after GnRHa treatment. METHODS: The subjects were included 77 girls who had sexual development during 8 to 9 years, and they were treated with GnRHa over 6 months. We analyzed chronologic age (CA), bone age (BA), predicted adult height (PAH), breast development and serum LH, FSH, E2 levels during and after treatment. Additionally we analyzed height and growth velocity of 17 subjects who were treated with GnRHa plus GH. RESULTS: CA was 8.7+/-1.1 yrs and BA was 10.3+/-1.7 yrs at diagnosis. Growth velocity was decreased from 7.4+/-2.0 cm/yr to 4.9+/-1.1 cm/yr during treatment, but they were increased to 7.9+/-1.7 cm/yr in 6 months off treatment. PAH SDS was increased from -1.9+/-1.6 to -1.5+/-1.5 during treatment. Serum E2 levels were decreased from 16.1+/-8.7 ng/dL to 9.4+/-2.4 ng/dL in 3 months after treatment and maintained in low level during treatment. But they began to increase at 3 months off treatment (P=0.059). Breast development was decreased in 3 months after treatment, however it began to increase in 3 months off treatment. Growth velocities were increased from 4.7 cm/yr to 6.6 cm/yr in 3months after combination treatment of GnRHa plus GH. PAH SDS was significantly increased in GnRHa plus GH treatment compared to GnRHa treatment only. CONCLUSION: GnRHa treatment suppressed rapid progress of early puberty effectively from start of treatment. It could be useful to relieve psychosocial problems in early puberty. PAH SDS was increased during GnRHa treatment, but it was increased more in GnRHa plus GH treatment. GH combination treatment should be considered if growth velocity was decreased seriously.

Effect of GnRH analogue on predicted adult height in girls with early puberty / 소아과

PURPOSE: The recent results observed in precocious puberty and the hope that interrupting puberty might increase adult height have led to an attempt to use GnRH agonist(GnRHa) in children with premature puberty and a poor growth prognosis. We aimed to analyze the growth promoting effect of GnRHa in girls with early puberty and low predicted adult height(PAH). METHODS: Thirty six girls were recruited. They were grouped according to the GnRHa treatment period(group 1>6 mo, n=18; group 2<6 mo, n=18). The following variables were analyzed before and after GnRHa treatment:chronological age(CA), bone age(BA), delta age(CA-BA), height, target height (TH), PAH, serum IGF-1, IGFBP-3. RESULTS: Duration of the GnRHa treatment was 0.89+/-0.81 yr(1.37+/-0.92 yr in group 1, and 0.41+/-0.08 yr in group 2). Before treatment, none of the variables were different between the two groups. There were no differences in the following variables the between two groups at the end of treatment:CA, BA, delta age, PAH, serum IGF-1, IGFBP-3. But, growth velocity(GV) and PAH increment during treatment were significantly reduced in group 1. Compared with initial PAH, PAH at the end of treatment was significantly increased(3.7+/-3.2 cm). The last serum levels of IGF-1 and IGFBP-3 were lower than those before treatment. CONCLUSION: Even though last PAH didn't approach TH, short term GnRHa administration in early puberty with low predicted PAH was somewhat effective. But, GnRHa administration suppressed the growth hormone-IGF-1 axis. Therefore, it is recommended that growth hormone(GH) should be used in combination with GnRHa.