Surpassing genetic height potential at final adult height after monthly depot leuprolide therapy in Taiwanese girls with central precocious or early puberty: a ROC-based analysis

Background Gonadotropin-releasing hormone agonists (GnRHa) are widely used to treat central precocious puberty (CPP), yet long-term outcomes based on confirmed final adult height (FAH) remain limited, particularly in Asian populations. Whether GnRHa therapy enables patients to surpass their genetically predicted height potential has not been well established. Methods This retrospective cohort study included 250 girls with central precocious puberty (CPP) or early puberty treated with depot leuprolide acetate (3.75 mg every 4 weeks) at Chang Gung Memorial Hospital (2003–2023). Among 84 patients with confirmed FAH, 73 were included after excluding those receiving growth hormone. Patients were categorized as FAH > mid-parental height (MPH) or FAH ≤ MPH. Clinical and auxological variables were analyzed, and ROC analysis evaluated the predictive value of age at treatment initiation. Results Among 73 patients, 39 (53.4%) achieved FAH exceeding MPH. These patients were younger at treatment initiation, had greater bone age advancement, and higher baseline height SDS, while absolute height was similar. During therapy, they maintained superior height SDS and growth velocity, resulting in a 6.57 cm greater FAH ( p < 0.001). ROC analysis showed modest discrimination (AUC ∼ 0.69), and no independent predictors were identified on multivariable analysis. Conclusion In conclusion, GnRHa therapy is associated with favorable height outcomes in a subset of patients, particularly with earlier initiation and sustained growth during treatment. These findings support a prognostic, individualized approach emphasizing skeletal maturity, pubertal tempo, and longitudinal growth monitoring.