LEUPROLİDE ASETAT TEDAVİSİ ALAN SANTRAL PUBERTE PREKOKS TANILI KIZ HASTALARDA UZUN DÖNEM SONUÇLAR

Öz

Amaç: Santral puberte prekoks (SPP), hipotalamo-hipofizer-gonadal (HHG) aksın erken aktivasyonuna bağlı olarak sekonder seks karakterlerinin kızlarda sekiz, erkeklerde dokuz yaşından önce görülmesidir. Bu çalışmada amaç; SPP tanısıyla leuprolide asetat tedavisi alan kız olguların tedavi bitiminden sonraki uzun dönem pubertal verilerini ve boy kazanımlarını araştırmaktır. Materyal ve Metot: Aralık 2002– Haziran 2013 tarihleri arasında SPP nedeniyle izlenen ve tedavi edilen toplam 70 kız olgu çalışmaya dahil edildi. Olguların dosya bilgilerinden anamnez, fizik muayene bulguları, anne-baba boyları, laboratuar ve radyolojik tetkikleri, tedavi öncesi ve tedavi bitimindeki boy, kilo, vücut kitle indeksi, hedef boy (MPH=midparenteral height) kaydedildi. Tedavinin başlangıcında ki tahmini erişkin boy (TEB) hesaplandı. Tedavinin kesilmesinden sonra olgular yeniden değerlendirildiğinde adet başlama yaşı ve düzeni, final boyları, VKİ kaydedildi. Bulgular: Leuprolide asetat tedavisi gören 70 hastada TEB 157.7±7.4 cm, MPH 158.3±4.5 cm, final boy 161.3±6.7 cm bulundu. Hastaların final boy uzunlukları ile başvuru anındaki boy yaşı, MPH değeri, başvuru anındaki ve tedavi bitimindeki boy uzunluğu arasında pozitif yönde bir ilişki saptandı ve istatistiksel olarak anlamlı kabul edildi (sırasıyla r=0.443, p<0.001, r=0.502, p<0.001, r=0.462, p<0.001 r=0.610, p<0.001). Hastaların %2.9’unda (n=2) adet düzensizliği tespit edildi. Olguların tedavi öncesi ve tedavi sonrası relatif VKİ’ları arasında fark saptanmadı. Sonuç: Leuprolide asetat tedavisinin HHG aksının baskılanması, pubertal bulguların ilerlemesinin durdurulması, menarşın geciktirilmesi ve final boyun korunmasında etkili olduğu gösterildi. Tedavinin adet düzensizliği, obeziteyi arttırıcı yönde yan etkilerinin olmadığı saptandı.

Anahtar Kelimeler

• Adet düzeni,Final boy,Leuprolide asetat,Obezite,Puberte prekoks

LONG-TERM RESULTS IN GIRLS WITH CENTRAL PRECOCIOUS PUBERTY AFTER LEUPROLIDE ACETATE TREATMENT

Abstract

Aim: Central precocious puberty (CPP) commonly refers to the development of pubertal sex characteristics as a consequence of the premature activation of the hypothalamic- pituitary-gonadal (HPG) axis before the age of eight years in girls and nine years in boys. This study’s aim is to research the female patinet`s long term lenght gains who received leuprolide acetate with a diagnose of CPP.

Material and Methods: Between December 2002 and June 2013, a total of 70 female patients who has been monitored of central precocious puberty included in the study. From the files of the cases; anamnesis, physical examination, height of mother and father, midparenteral height (MPH) laboratory and radiological findings and weight, height and body mass index (BMI) before and after treatment recorded.

Results: In 70 patients diagnosed as CPP and given leuprolide acetate treatment average for 21.73±8.45 months, predicted adult height(PAH) 157.7±7.4 cm, MPH 158.3±4.5 cm, final height found as 161.3±6.7 cm. There was a statiscally significant positive correlation  between final height and height age, MPH value, height on admission and after treatment (r=0.443, p<0.001, r=0.502, p<0.001, r=0.462, p<0.001 r=0.610, p<0.001 in order). %2.9 of the patients have irregular menstruel periods. There was statistically significant relation of BMI between before and after the treatment.

Conclusion: It is shown that Leuprolide acetat therapy is efficient in suppressing HHG axis, preventing the advancement of pubertal findings, prolonging the menarch and preserving the final height. The treatment showed no adverse effects on increasing obesity and menstrual irregularity.

Keywords

• menstruration,Leuprolide acetate,Obesity,Precocious puberty

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