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Rakesh Kumar, Puja Bhagat Department of Pediatrics, Katihar Medical College, Katihar, Bihar, India ...

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Question
7yrs old girl,32kgs, 135cms at present with tanner's 3 thelarche and tanner's 2 adrenarche, not yet attained menarche. Bone age 11yrs. . Leuprolide stimulaion test is positive. Other hormonal assay, MRI brain USG abdomen are all normal. What would be the line of management? Should we start medroxy progesterone with leuprolide to prevent spotting as mother is anxious about the spotting? Id so what would be the correct dosage? Should GH be added with Leuprolide for full height potential? Will she attain the full expected height? What are the other problems to be expected?
Answer
This child needs GnRh analogue therapy in the form of injection Decapeptyl 3.75 mg i.m once a month for 2-4 years. she also needs to be on Medroxyprogesterone in the first 3 months in a dose of 10 mg hs. Despite medroxyprogesterone spotting may occur in the first 2-3 months of therapy. Her final height potential can be a problem but it is difficult to predict height without seeing the x ray. She may benefit from GH therapy if her final height is going to be less. Back to All Questions

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