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- How to treat a child with GDPP associated with an intracranial
pathology?
Neurosurgical intervention is the treatment of choice in most patients with
GDPP due to intracranial pathology, except in those with uncomplicated hypo-
thalamic hamartoma. Despite curative surgery, medical therapy needs to be
continued for the management of precocious puberty, as HPG-axis remains
active once stimulated. - How to treat a child with precocious puberty due to hypothalamic
hamartoma?
Hypothalamic hamartoma is a slowly growing heterotopic mass comprised of
disorganized neuronal tissue. These “tumors” cease to grow after the age of
8–12 years, as the development of brain tissue is complete by this age. GnRH
agonist therapy is the treatment of choice for precocious puberty associated
with hypothalamic hamartoma. Although there is regression of secondary
sexual characteristics, size of hamartoma does not change with GnRH agonist
therapy. Surgical intervention is required only in those with refractory seizures
or mass effects. - Do all children with GDPP require therapy?
Children with GDPP due to an organic cause should always be treated. Rapid
progression of pubertal events over a period of 3–6 months, significant advance-
ment of bone age (>2.5 SD for chronological age), or presence of psychosocial
concerns are the indications of therapy in children with idiopathic
GDPP. However, all children with idiopathic GDPP who do not require therapy
should be kept under regular surveillance.- A 5-year-old girl child presented with thelarche. On evaluation, she had Tanner
breast stage B 3 , height of 108 cm ( 50 th percentile), and bone age of 6.5 years,
and MRI brain was normal. Biochemical evaluation confirmed a diagnosis of
GDPP. How to proceed further?
Rapid advancement of puberty, accelerated height velocity, and significant
advancement in bone age merit therapy in children with idiopathic GDPP. The
index patient had idiopathic GDPP and at presentation, information regarding
the rapidity of progression of secondary sexual characteristics and growth
velocity were not available. In such a scenario, bone age may be a simple tool
in deciding the need for therapy. Bone age of the child was 6.5 years and it was
not significantly advanced (bone age <2.5 SD over chronological age), and
hence a decision was made to closely follow up the child for progression of
pubertal events and height velocity.
6 Precocious Puberty