PEDI

Question 1

TREATMENT FOR
central PRECOCIOUS PUBERTY

Answer 1

Short-acting GnRH agonists:
• Naraelin (Synarel)
•Intranasal administration QD
•Total duration of tx should not exceed 6
months (decreased bone density)
•
Long-acting GnRH agonists:
•. Results in an initial transient stimulation of
gonadotropin secretion from the pituitary, followed
by a complete, but reversible, suppression of
pituitary-gonadal axis.
•. Triptorelin pamoate (Gonapeptyl)
•. IM injection (no age restrictions)
•. Leuprolide acetate (Lupron)
•. IM injection for children ages 1 month+,
Q28D
•. Histrelin acetate SubQ Implant (Supprelin LA)
•. SubQ implant for children ages 2+; 50mg
implant surgically implanted Q12M
(releases approximately 65 mcg QD x 12M)

Question 2

treatment for peipheral precocious puberty

Answer 2

Tumor of testis/adrenal gland/ovary: surgery
•Functioning follicular cyst of the ovary: conservative
management (watch/wait)
•Exposure to exogenous sex steroids: remove the source
•Congenital adrenal hyperplasia: Glucocorticoids
(Hydrocortisone, Fludrocortisone, Dexamethasone,
Prednisone, Prednisolone)
•McCune-Albright syndrome:
•Males:
•Combo therapy with antiandrogen (androgen
receptor antagonist: spironolactone,
bicalutamide) and an aromatase inhibitor
(anastrozole).
•Females:
•Letrozole
•Testolactone
•Tamoxifen
•Fulvestrant

Question 3

PEDI
FDA APPROVED FOR dm MANAGEMENT

Answer 3

metformin : first line therapy in association with diet and exercise

liraglutide and exendatide : fda approved second line agents

glp 1’s glucagon like peptide 1 agonists

trial thesebefore insulin, given their potential benefits on weight as glycemic control