Central Precocious Puberty as a Complication of Therapy with Adrenocorticotropin (ACTH) and an Aromatase Inhibitor for Refractory Nephrotic Syndrome

Table 1

Laboratory test results and medication dose at different time intervals.

	Reference range	Month 0^a	Month 1^b	Month 2^c	Month 4^d	Month 8^e	Month 20^f
Treatment	n/a	—	—	Anastrozole	Anastrozole, lupron	Anastrozole, lupron	Anastrozole, lupron
LH (mIU/ml)	<0.2	0.12	1.4	4.7	1.7	0.5	0.3
FSH (mIU/ml)	1–4.2	1.7	2.6	7.5	5.5	0.6	0.8
Estradiol (pg/ml)	5–20	12.6	<10	42.9	67.3	<10	<10
Testosterone (ng/dl)	<2.5–10	—	36	24	35	25	<13
Cortisol AM (mcg/dl)	3–21	69.1	6.1	4.2	2.6	5.6	1.2
17-OHP (ng/dl)	<91	71	—	32	24	9	<0.8
DHEA (ng/dl)	19–592	1096	—	—	206	177	167
DHEAS (mcg/dl)	<92	396	—	268	194	142	150
Androstenedione (ng/dl)	6–115	—	—	188	229	143	18

We attribute the apparent rapid fall of cortisol due to timing of sample in relation to ACTH administration. ^aACTH 40 units three times/week. ^bACTH 40 units twice/week and 32 units once/week. ^cACTH 40 units once/week and 32 units twice/week, started anastrozole 0.5 mg/day. ^dACTH 32 units three times/week, anastrozole 0.5 mg/day, started LHRH 30 mg once/3 months. ^eACTH 24 units twice/week, anastrozole 0.5 mg/day, LHRH 30 mg IM once/3 months. ^fACTH 8 units once/week, prednisolone 3 mg six times/week, anastrozole 0.5 mg/day, LHRH 30 mg IM once/3 months.