Q: My 8 years old daughter is showing signs of early puberty. It has been diagnosed so and the doctor says the drug luprolide acetate may need to be injected monthly. We are going back to India in 4 months. I would like to know if the drug is available in India and whether it has any long term side effects such as fertility problems, etc?

A:There is some confusion about the age at which central precocious puberty (CPP) is diagnosed in female children. The international consensus so far was below 8 years. However, recent review in the United States has led to lowering the age further down to 7 years in whites and 6 years in black Americans. Your daughter was over 8 years 3 months old. Based on clinical judgement alone, it is doubtful if the diagnosis of central precocious puberty can be made. How was the diagnosis confirmed? One of the major problems with CPP is that child does not gain height. Your daughter with a weight of 30 kg and height of 4 feet 7 inches appears to be normal. A consultation with a good endocrinologist is called for. It is true that leuprolide is given in the confirmed, diagnosed cases of CPP but its efficacy in the age group of 6-8 years is not fully established. Leurpolide is marketed in India. As you know it is principally an anti-cancer drug.