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Chữa trị Ba đại lý nguyên tắc đã được sử dụng trong điều trị CPP: medroxyprogersterone acetate (MPA), cyproterone acetate (CPA) và các chất chủ vận GnRH. Khu bảo tồn biển và CPA đảo ngược hoặc bắt giữ các tiến triển của đặc trưng giới tính thứ | Treatment Options Three principle agents have been used in CPP therapy medroxyprogers-terone acetate MPA cyproterone acetate CPA and GnRH agonists. MPA and CPA reverse or arrest the progression of secondary sex characterises but have little to no effect on hormonal suppression 117 118 and auxological outcome 4 119 . In addition both agents have undesirable side effects 4 120 . With the availability of GnRH agonists synthetic analogues of the natural GnRH decapeptide MPA and CPA have become obsolete in the treatment of children with CPP. GnRH agonists bind to the GnRH receptor in the pituitary gland resulting in desensitization of the gonadotropins to GnRH and downregulation of pituitary GnRH receptors 121 122 so that gonadotropin release is gradually inhibited after an initial stimulatory phase flare-up 123 . Additionally GnRH agonist treatment leads to a disturbed transcription of LH a and 3 subunit gene. The 3 subunit amount decreases dramatically the a subunit secretion is stimulated by exogenous GnRH administration 124 resulting in an ineffective LH. The first reports of successful short-term pituitary-gonadal suppression in CPP patients by GnRH agonists date back to 1981 8 125 126 . Since then numerous studies have been performed to investigate the psychological hormonal and auxological effects of GnRH agonists in CPP children and to define the outcome after treatment. Several GnRH agonists have been used in studies on treatment of CPP since different compounds are licensed for the use in children in different countries. Routes and frequency of administration include 1-3 daily subcutaneous injections multiple daily intranasal applications and monthly intramuscular or subcutaneous depot injections. Depot preparations of GnRH agonists 9 suppress the pituitary-hormonal axis far better than the daily subcutaneous or nasal preparations 127-129 probably due to improved patient compliance. The most widely used drugs are triptorelin depot 9 10 130 131 and leuprorelin
