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in efficacy of these drugs. Other aromatase inhibitors like fadrozole and anas-

trozole or selective estrogen receptor modulator tamoxifen has not been found

to be useful in the management of GIPP associated with MAS. Fulvestrant, a

pure antiestrogen, has been shown to be effective in some of these children.

77. What are the long-term complications associated with precocious puberty in girls?

Few studies have shown an increased incidence of obesity and polycystic ovar-

ian disease in children with GDPP on follow-up; however, long-term data do

not support this observation. Fertility is not impaired in these individuals, and

women with GDPP are not predisposed for early menopause. The risk of

estrogen- dependent malignancies is not increased in these women. Patients

with isolated premature pubarche are at a higher risk for the development of

polycystic ovarian disease due to coexisting hyperinsulinemia

Further Readings

1. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Human
   Reprod Update. 2004;10:135–47.


2. Carel J, Léger J. Precocious puberty. N Engl J Med. 2008;358:2366–77.


3. Carel JC, Roger M, Ispas S, Tondu F, Lahlou N, Blumberg J, Chaussain JL, Group T.F.t.s.
   Final height after long-term treatment with triptorelin slow-release for central precocious
   puberty: importance of statural growth after interruption of treatment. J Clin Endocrinol
   Metab. 1999;84:1973–8.


4. Carel JC, et al. Final height after long-term treatment with triptorelin slow release for central
   precocious puberty: importance of statural growth after interruption of treatment. French study
   group of decapeptyl in precocious puberty. J Clin Endocrinol Metab. 1999;84:1973–8.


5. Cesario SK, Hughes LA. Precocious puberty: a comprehensive review of literature. J Obstet
   Gynecol Neonatal Nurs. 2007;36:263–74.


6. DeGroot L, Jameson J. Endocrinology. Philadelphia: Saunders/Elsevier; 2010.


7. Dumitrescu CE, Collins MT. McCune-Albright syndrome. Orphanet J Rare Dis. 2008;3:12.


8. Freire A, Escobar M, Gryngarten M, Arcari A, Ballerini M, Bergadá I, et al. High diagnostic
   accuracy of subcutaneous Triptorelin test compared with GnRH test for diagnosing central
   precocious puberty in girls. Clin Endocrinol. 2013;78:398–404.


9. Kaplowitz P, Oberfield S. Reexamination of the age limit for defining when puberty is preco-
   cious in girls in the United States: implications for evaluation and treatment. Pediatrics.
   1999;104:936–41.


10. Melmed S, Williams R. Williams textbook of endocrinology. Philadelphia: Elsevier/
    Saunders; 2011.


11. Mul D, Hughes I. The use of GnRH agonist in precocious puberty. Eur J Endocrinol. 2008;
    159(S1):S3–8.


12. Partsch C, Sippell W. Treatment of central precocious puberty. Best Pract Res Clin Endocrinol
    Metab. 2002;16:165–89.


13. Sathasivam A, Garibaldi L, Shapiro S, Godbold J, Rapaport R. Leuprolide stimulation testing
    for the evaluation of early female sexual maturation. Clin Endocrinol. 2010;73:375–81.

6 Precocious Puberty