Psychological Behavior Problems In Children With Central Precocious Puberty Treated By Long-acting GnRHa

Research BackgroundThe incidence of precocious puberty in children has increased worldwide in last decades,which brings a series of hazards to children.Early closure of epiphysis affects lifelong high.Early menarche in girls and sexual maturity lead to different degrees of psychological behavior problems.Gonadotropin-releasing hormone analogue(GnRHa)have been used in the treatment for central precocious puberty(CPP)since 1980s,which can slow down the progression of bone age,improve the lifelong height,and alleviate the psychological behavior problems in children with CPP.Relating research mainly focused on its influence on lifetime high,but a few ones on psychological behavior.Long-acting GnRHa was marketed and came into clinical application in China is late,and its effectiveness and safety need further study.ObjectiveTo investigate psychological behavior problems in CPP children,and to compare the long-acting and short-acting GnRHa on bone age,predicted adult height,and psychological behavior problems.Explore the differences of psychological behavior problems in CPP children and the correlation between the levels of sex hormone and behavioral factors.MethodsChildren diagnosed with precocious puberty in the Department of Pediatric Endocrinology,Bao’an People’s Hospital,Shenzhen,from September 2020 to August 2021 were included in a cohort study,and their growth data(height,weight,body mass index,etc.)were collected every 3 months and followed up 9 months.According to the different dosage forms of GnRHa treatment,they were divided into long-acting group and short-acting group,and their medical records were collected to evaluate the efficacy of long-acting GnRHa in CPP children.The psychological behavior problems in CPP children were assessed before and after GnRHa treatment by the Achenbach’s Child Behavior Checklist(CBCL),and to compare the difference between the two groups.ResultsA total of 35 CPP children were included in this study,31 girls and 4 boys.Among them 13 girls and one boy had behavioral problems.There were 15 children in long-acting group,6 of whom had behavioral problems.There were 20 children in the short-acting group,8 of whom had behavioral problems.The scores of endogenous behavior problems,depression,social withdrawal,schizotypal compulsion and sexual problems in CPP girls before treatment with long-acting GnRHa were statistically high than those after treatment(P<0.05).There was negative correlation between E2 and depression factor score of girls with precocious puberty(r=-0.574,P=0.032).Depression factor score and body complaint factor score of precocious girls were negatively correlated with FSH(r=-0.607,P=0.021;r=-0.699,P=0.005).Body complaint factor score and hyperactivity factor score of precocious girls were negatively correlated with LH(r=-0.602,P=0.023;r=-0.572,P=0.033).Sexual hormone levels in precocious girls decreased before and after treatment with long-acting GnRHa,and the difference was statistically significant,but there was no significant difference between long-acting group and short-acting group.The bone age,standard deviation of height and predicted adult height of precocious girls improved after treatment with long-acting GnRHa,but there was no significant difference between long-acting group and short-acting group(P>0.05).ConclusionChildren with CPP have different forms of psychological behavior problems,mainly manifested in depression,social withdrawal,violation of discipline.The scores of behavioral factors such as depression,social withdrawal,schizotypal compulsion and sexual problems were improved in CPP girls treated with long-acting GnRHa.There is a correlation between E2、LH and FSH in children with CPP.Long-acting GnRHa can effectively inhibit the gonadal axis,reduce the level of sex hormones in vivo,delay the progression of bone age and improve adult height.