Final adult height in children with central precocious puberty - a retrospective study.

Background/Aims: Central precocious puberty (CPP) is due to premature activation of the hypothalamic-pituitary-gonadal axis. It predominantly affects girls. CPP leads to lower final height (FH), yet the treatment benefit in girls between 6 and 8 years is equivocal. Our main goal was to evaluate the effects of gonadotropin-releasing hormone analog (GnRHa) on FH and identify factors that predict FH. Methods: In a retrospective study, children with CPP (12 boys, 81 girls) that reached FH were included. Their clinical data at diagnosis and up to their final height was compared by descriptive statistics among idiopathic (iCPP) (n=68) and non-idiopathic CPP (nCPP) and between GnRHa treated (n=48) and untreated (n=15) girls with iCPP. The treatment effect of body weight (BW) adjusted GnRHa dosing was evaluated. Univariate linear regression and step-wise multivariable regression including 48 girls with iCPP treated with GnRHa were performed to identify predicting factors for FH. Results: Children with idiopathic CPP (iCPP) reached higher FH (p=0.002) than children with non-idiopathic CPP. After the diagnosis, the treated group gained 7.0 cm more than the untreated group. Yet, attributable to individualized decision-making, the FH in both groups was comparable (161.5 cm in treated, 161.0 cm in untreated girls with iCPP), although the onset of menarche was 2.5 years earlier among untreated girls. BW-adjusted dosing suppressed peak luteinizing hormone (LH) below 4.5 IU/L in 95% of children; however, bone age further advanced during therapy in 38% of patients. Predicting factors revealed by multivariable regression were bone age at diagnosis, BMI SDS at diagnosis, LH basal, age at start and cessation of treatment, predicted adult height and target height. (R2 = 0.72). Conclusion: Children with nCPP had worse FH outcome compared to iCPP despite similar CPP onset and therapeutic characteristics. Treatment by GnRHa using BW-adjusted dosing was effective in delaying menarche onset and reaching target height in girls with iCPP. Multiple factors affecting FH outcome indicated individualized decision-making regarding therapeutic intervention remains challenging. In the treated patients, among the factors that can be influenced, height at treatment cessation most significantly influenced the outcome.

An Atypical Chronic Ulcer Caused by Acute Myeloid Leukemia.

INTRODUCTION: Atypical chronic wounds are challenging for clinicians because of their identification, diagnosis, and treatment. These wounds may reflect an underlying systemic or malignant disease; therefore, an accurate diagnosis and initiation of the appropriate treatment are necessary. CASE REPORT: A 68-year-old man presented with an atypical chronic ulcer on his left shin of 2 years' duration. The ulcer was associated with acute myeloid leukemia. Initially, the surgeon treated the chronic wound with wide debridement and biopsy for pathohistological investigation. Leukemia cutis with accumulation of blast cells in the area of the ulcer was recognized by histological examination. Further, an absorbent cellulose-based core dressing with activated carbon was used, which appeared to be useful in reducing wound pain, odor, and exudate. CONCLUSIONS: Leukemia cutis is a specific sign of systemic leukemia and the result of dissemination of leukemic cells to the skin. Treatment should be directed towards eradication of the systemic disease, which also improves local manifestation of the disease.