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Santral Puberte Prekoks Tanılı Kızlarda GNRH Analog Tedavisinin Antropometrik Ölçüm Değerlerine etkisi: Bir Yıllık Takip Sonuçları

Year 2024, Volume: 46 Issue: 4, 538 - 544, 16.07.2024
https://doi.org/10.20515/otd.1383498

Abstract

GnRH analogları (GNRHa) santral puberte prekoksta(SPP) altın standart tedavi yöntemidir. GnRHa tedavisi ile vücut kitle indeksinde (VKİ) artış olduğunu, değişmediğini ve azalabileceğini bildiren çalışmalar mevcuttur. Bu çalışmada; SPP’li kızlarda GnRHa tedavisinin birinci yılında boy, ağırlık, VKİ değerleri ile bel çevresi, bel çevresi/boy oranındaki değişimin değerlendirmesi amaçlanmıştır. Hastanemizde SPP tanısıyla GnRHa tedavisi başlanan 63 kız olgu dahil edildi. Tedavi öncesi/tedavinin birinci yılında boy, ağırlık, VKİ, bel çevresi ölçümleri yapıldı. Veriler SPSS 25.0 yazılımı kullanılarak analiz edildi. Yaş ortalaması 8,41±0,92 yıl idi. Olguların boy, vücut ağırlığı, VKİ, öngörülen son boy (ÖSB), bel çevreleri ölçüm ortalamaları tedavi öncesine göre birinci yılda istatistiksel olarak çok önemli artış gösterdi (p<0,001). Olguların birinci yıl bel çevresi persentil değerleri tedavi öncesine göre artmış bulundu (p=0,002). VKİ persentili ≥%85 olanların yüzdesi tedavi öncesi ve tedavinin birinci yılında sırasıyla; %50,8 ve %58,7 idi (p=0,180). Tedavi öncesi VKİ <85 persentil(n=31) ve ≥85 persentil(n=32) olarak iki grupta değerlendirildiğinde; tedavinin birinci yılında her iki grubun bel çevresi/boy oranı, bel/kalça çevresi oranı, VKİ sds, boy sds değerlerinde anlamlı değişim görülmedi. GnRHa tedavisiyle boy, vücut ağırlığı, VKİ, ÖSB, bel çevreleri, bel çevresi persentilleri artmıştır. Başlangıçta VKİ<85 persentil ve VKİ ≥85 persentil olgularda, tedavinin birinci yılında VKİ sds, boy sds değerleri ile bel çevresi/boy oranı, bel/kalça çevresi oranları açısından değişiklik gözlenmemiştir. SPP’li kızlarda GnRHa tedavisinin uzun dönem etkilerini daha uzun süreli ve daha büyük gruplarda araştıran ileri çalışmalara ihtiyaç vardır.

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References

  • 1. Çetinkaya S., Endokrin çevre bozucular ve ergenlik üzerine etkileri, Dicle Tıp Dergisi, 2009; 36 (1): 59-66.
  • 2. Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009; 123:752–762.
  • 3. De Kroon MLA, Renders CM, van Wouwe JP, van Buuren V, Hirasing RA. The Terneuzen Birth Cohort: BMI change between 2 and 6 years is most predictive of adult cardiometabolic risk. PLoS One 2010; 5 (11); e13966.
  • 4. Barker DJP, Osmond C, Forsén TJ, Kajantie E, Eriksson JG. Trajectories of growth among children who have coronary events as adults. N Engl J Med 2005; 353(17):1802-9.
  • 5. Paterson WF, McNeill E, Young D, Donaldson MD. Auxological outcome and time to menarche following long-acting goserelin therapy in girls with central precocious or early puberty. Clin Endocrinol 2004;61: 626–34.
  • 6. Lee SJ, Yang EM, Seo JY, Kim CJ. Effects of gonadotropinreleasing hormone agonist therapy on body mass index and height in girls with central precocious puberty. Chonnam Med J 2012;48:27–31.
  • 7. Pasquino AM, Pucarelli I, Accardo F, Demiraj V, Segni M, et al. Long-term observation of 87 girls with idiopathic central precocious puberty treated with gonadotropin-releasing hormone analogs: impact on adult height, body mass index, bone mineral content, and reproductive function. J Clin Endocrinol Metab 2008;93:190–5.
  • 8. Arrigo T, De Luca F, Antoniazzi F, Galluzzi F, Segni M, et al. Reduction of baseline body mass index under gonadotropinsuppressive therapy in girls with idiopathic precocious puberty. Eur J Endocrinol 2004;150:533–7.
  • 9. Van der Sluis IM, Boot AM, Krenning EP, Drop SL, de Muinck Keizer-Schrama SM. Longitudinal follow-up of bone density and body composition in children with precocious or early puberty before, during and after cessation of GnRH agonist therapy. J Clin Endocrinol Metab 2002;87:506–12.
  • 10. Wolters B, Lass N, Reinehr T. Treatment with gonadotropinreleasing hormone analogues: different impact on body weight in normal-weight and overweight children. Horm Res Paediatr 2012;78:304–11.
  • 11. Vuralli D, Ozon ZA, Gonc EN, Alikasifoglu A, Kandemir N. Long-term effects of GnRH agonist treatment on body mass index in girls with idiopathic central precocious puberty. J Pediatr Endocrinol Metab. 2020 Jan 28;33(1):99-105.
  • 12. Loochi SA, Demol S, Nagelberg N, Lebenthal Y, Phillip M, Yackobovitch-Gavan M. Gonadotropin releasing hormone analogue therapy in girls with idiopathic precocious puberty/early-fast puberty: dynamics in adiposity indices, eating habits and quality of life. J Pediatr Endocrinol Metab. 2021 Feb 22;34(3):373-383.
  • 13. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update 2004;10:135–47.
  • 14. Demir K, Özen S, Konakçı E, Aydın M, Darendeliler F. A Comprehensive Online Calculator for Pediatric Endocrinologists: ÇEDD Çözüm/TPEDS Metrics. J Clin Res Pediatr Endocrinol 2017; 9:182–184.
  • 15. Nazlı EG. Obezitede beslenme. Özen H (Eds.) Soru ve cevaplarla çocuk beslenmesi. 1. Baskı. Akademi Yayınevi. 2015;374-85.
  • 16. Unalan D, Senol V, Bayat M, Mazicioglu MM, Ozturk A, Kurtoglu S, Hatipoglu N, Ustunbas HB. Change in waist circumference over 3 years in Turkish children and adolescents. Ann Hum Biol. 2013 Sep-Oct;40(5):419-25.
  • 17. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969; 44:291–303.
  • 18. Milner GR, Levick RK, Kay R. Assessment of bone age: a comparison of the Greulich and Pyle, and the Tanner and Whitehouse methods. Clin Radiol 1986; 37: 119–21.
  • 19. Chiumello G, Brambilla P, Guarneri MP, Russo G, Manzoni P, Sgaramella P. Precocious puberty and body composition: effects of GnRH analog treatment. J Pediatr Endocrinol Metabol 2000;13 Suppl 1:791-4.
  • 20. Messaaoui A, Massa G, Tenoutasse S, Heinrichs C. [Treatment of central precocious puberty with Gonadotropin-Releasing Hormone agonist (triptorelin) in girls: breast development, skeletal maturation, height and weight evolution during and after treatment]. Rev Med Brux 2005; 26(1):27-32.
  • 21. Guaraldi F, Beccuti G, Gori D, Ghizzoni L. Long-term outcomes of the treatment of central precocious puberty. Eur J Endocrinol 2016;174:R79–87.

Effect of GNRH Analogue Treatment on Anthropometric Measurements in Girls Diagnosed with Central Precocious Puberty: One-Year Follow-up Results

Year 2024, Volume: 46 Issue: 4, 538 - 544, 16.07.2024
https://doi.org/10.20515/otd.1383498

Abstract

GnRH analogs(GNRHa) are the gold standard treatment for central precocious puberty(CPP).There are studies reporting that body-mass-index(BMI) increases, does not change and can decrease with GnRHa treatment. In this study; It was aimed to evaluate the changes in height, weight,BMI values, waist-circumference, waist-circumference/height ratio in girls with SPP in the first-year of GnRHa treatment. We included 63 female patients who were started on GnRHa treatment with the diagnosis of SPP in our hospital. Height, weight, BMI, waist-circumference were measured before treatment/in the first-year of treatment. Data were analyzed using SPSS25.0software. Results: The mean age was 8.41±0.92years. Mean height, body weight, BMI,predicted adult height(PAH),waist-circumference of the subjects increased statistically significantly in the first year compared to pre-treatment (p<0.001).The first-year waist-circumference percentile values of the cases were found to be higher than before the treatment(p=0.002).Percentage of those with BMI percentile≥85% before treatment and in the first year of treatment, respectively; were 50.8%,58.7%(p=0.180).When the pre-treatment BMI was evaluated in two groups as<85th percentile(n=31) and ≥85th percentile(n=32);There was no significant change in waist-circumference/height ratio, waist/hip circumference ratio, BMI sds, height sds values of both groups in the first year of treatment. Height,weight,BMI,PAH,waist-circumferences, waist-circumference percentiles increased with GnRHa treatment. In subjects with BMI <85th percentile and BMI ≥85th percentile at baseline, no change was observed in BMI sds, height sds values, waist-circumference/height ratio, waist/hip-circumference ratios in the first year of treatment. Further studies are needed to investigate the long-term effects of GnRHa therapy in girls with SPP,with longer duration and in larger groups.

References

  • 1. Çetinkaya S., Endokrin çevre bozucular ve ergenlik üzerine etkileri, Dicle Tıp Dergisi, 2009; 36 (1): 59-66.
  • 2. Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009; 123:752–762.
  • 3. De Kroon MLA, Renders CM, van Wouwe JP, van Buuren V, Hirasing RA. The Terneuzen Birth Cohort: BMI change between 2 and 6 years is most predictive of adult cardiometabolic risk. PLoS One 2010; 5 (11); e13966.
  • 4. Barker DJP, Osmond C, Forsén TJ, Kajantie E, Eriksson JG. Trajectories of growth among children who have coronary events as adults. N Engl J Med 2005; 353(17):1802-9.
  • 5. Paterson WF, McNeill E, Young D, Donaldson MD. Auxological outcome and time to menarche following long-acting goserelin therapy in girls with central precocious or early puberty. Clin Endocrinol 2004;61: 626–34.
  • 6. Lee SJ, Yang EM, Seo JY, Kim CJ. Effects of gonadotropinreleasing hormone agonist therapy on body mass index and height in girls with central precocious puberty. Chonnam Med J 2012;48:27–31.
  • 7. Pasquino AM, Pucarelli I, Accardo F, Demiraj V, Segni M, et al. Long-term observation of 87 girls with idiopathic central precocious puberty treated with gonadotropin-releasing hormone analogs: impact on adult height, body mass index, bone mineral content, and reproductive function. J Clin Endocrinol Metab 2008;93:190–5.
  • 8. Arrigo T, De Luca F, Antoniazzi F, Galluzzi F, Segni M, et al. Reduction of baseline body mass index under gonadotropinsuppressive therapy in girls with idiopathic precocious puberty. Eur J Endocrinol 2004;150:533–7.
  • 9. Van der Sluis IM, Boot AM, Krenning EP, Drop SL, de Muinck Keizer-Schrama SM. Longitudinal follow-up of bone density and body composition in children with precocious or early puberty before, during and after cessation of GnRH agonist therapy. J Clin Endocrinol Metab 2002;87:506–12.
  • 10. Wolters B, Lass N, Reinehr T. Treatment with gonadotropinreleasing hormone analogues: different impact on body weight in normal-weight and overweight children. Horm Res Paediatr 2012;78:304–11.
  • 11. Vuralli D, Ozon ZA, Gonc EN, Alikasifoglu A, Kandemir N. Long-term effects of GnRH agonist treatment on body mass index in girls with idiopathic central precocious puberty. J Pediatr Endocrinol Metab. 2020 Jan 28;33(1):99-105.
  • 12. Loochi SA, Demol S, Nagelberg N, Lebenthal Y, Phillip M, Yackobovitch-Gavan M. Gonadotropin releasing hormone analogue therapy in girls with idiopathic precocious puberty/early-fast puberty: dynamics in adiposity indices, eating habits and quality of life. J Pediatr Endocrinol Metab. 2021 Feb 22;34(3):373-383.
  • 13. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update 2004;10:135–47.
  • 14. Demir K, Özen S, Konakçı E, Aydın M, Darendeliler F. A Comprehensive Online Calculator for Pediatric Endocrinologists: ÇEDD Çözüm/TPEDS Metrics. J Clin Res Pediatr Endocrinol 2017; 9:182–184.
  • 15. Nazlı EG. Obezitede beslenme. Özen H (Eds.) Soru ve cevaplarla çocuk beslenmesi. 1. Baskı. Akademi Yayınevi. 2015;374-85.
  • 16. Unalan D, Senol V, Bayat M, Mazicioglu MM, Ozturk A, Kurtoglu S, Hatipoglu N, Ustunbas HB. Change in waist circumference over 3 years in Turkish children and adolescents. Ann Hum Biol. 2013 Sep-Oct;40(5):419-25.
  • 17. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969; 44:291–303.
  • 18. Milner GR, Levick RK, Kay R. Assessment of bone age: a comparison of the Greulich and Pyle, and the Tanner and Whitehouse methods. Clin Radiol 1986; 37: 119–21.
  • 19. Chiumello G, Brambilla P, Guarneri MP, Russo G, Manzoni P, Sgaramella P. Precocious puberty and body composition: effects of GnRH analog treatment. J Pediatr Endocrinol Metabol 2000;13 Suppl 1:791-4.
  • 20. Messaaoui A, Massa G, Tenoutasse S, Heinrichs C. [Treatment of central precocious puberty with Gonadotropin-Releasing Hormone agonist (triptorelin) in girls: breast development, skeletal maturation, height and weight evolution during and after treatment]. Rev Med Brux 2005; 26(1):27-32.
  • 21. Guaraldi F, Beccuti G, Gori D, Ghizzoni L. Long-term outcomes of the treatment of central precocious puberty. Eur J Endocrinol 2016;174:R79–87.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Pediatric Endocrinology
Journal Section ORİJİNAL MAKALE
Authors

Şervan Özalkak 0000-0002-1557-6040

Melikşah Keskin 0000-0002-2713-3618

Gülin Karacan 0000-0001-7506-1711

Şenay Savaş Erdeve 0000-0002-4164-5089

Semra Çetinkaya 0000-0003-3974-2872

Publication Date July 16, 2024
Submission Date October 31, 2023
Acceptance Date June 11, 2024
Published in Issue Year 2024 Volume: 46 Issue: 4

Cite

Vancouver Özalkak Ş, Keskin M, Karacan G, Savaş Erdeve Ş, Çetinkaya S. Santral Puberte Prekoks Tanılı Kızlarda GNRH Analog Tedavisinin Antropometrik Ölçüm Değerlerine etkisi: Bir Yıllık Takip Sonuçları. Osmangazi Tıp Dergisi. 2024;46(4):538-44.


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