Commentary on "Treatment of overweight and obese girls experiencing central precocious puberty: a comparison of the effectiveness of leuprolide acetate and triptorelin pamoate"

Effective management of central precocious puberty (CPP) in girls requires careful clinical judgment, especially in the context of increasing childhood obesity and earlier onset of puberty. In this issue of Annals of Pediatric Endocrinology & Metabolism, Thaneetrakool et al. [1] compare leuprolide acetate and triptorelin pamoate in overweight and obese girls with CPP, showing both agents yield similar results in pubertal suppression, bone age advancement, and body mass index (BMI) change over 12 months.

While gonadotropin-releasing hormone (GnRH) agonist therapy has occasionally raised concerns about promoting weight gain, particularly in girls with higher baseline BMI [2], this study found no significant differences in BMI progression between the 2 treatments. These findings support clinical flexibility in agent selection without compromising metabolic outcomes.

The results are consistent with previous findings by Jang et al. [3], who reported no significant difference in outcomes between fixed and weight-based GnRH agonist dosing. Similarly, long-term follow-up by Hwangbo et al. [4] showed that GnRH agonist treatment maintains stable growth and metabolic profiles over time, adding further reassurance about the safety of these therapies.

The 2022 Korean CPP guidelines emphasize that agent selection should consider factors such as availability, adherence, and clinical logistics, rather than presumed differences in efficacy [2]. The current study supports this principle by showing that both medications are viable therapeutic options, even in higher-risk populations such as overweight children.

The inclusion of Thai patients in the current study enhances its regional relevance. As shown by Yaisilp et al. [5], early puberty is becoming more common in Thai girls, especially among those with higher BMI, reinforcing the relevance of this study to broader clinical practice in Asia and globally.

In conclusion, the findings of Thaneetrakool et al. [1] support the use of both leuprolide acetate and triptorelin pamoate as effective treatment options for CPP in overweight girls. These results highlight that, in real-world care, treatment decisions are often guided less by pharmacologic differences and more by what is practical—what the patient and family can access, adhere to, and sustain over time. As the number of children with CPP and obesity continues to rise, this study provides evidence-based guidance for treatment decisions.