Erken puberte açısından değerlendirilen obez ve obez olmayan kız çocuklarının klinik, laboratuvar ve radyolojik verilerinin karşılaştırılması

Year 2020, Volume: 13 Issue: 2, 487 - 494, 14.05.2020

Deniz Özalp Kızılay , Hale Ünver Tuhan

https://doi.org/10.31362/patd.664874

Abstract

Amaç: Erken puberte (EP) etiyolojisinde, genetik faktörler sorumlu tutulsa da beslenme ve çevresel faktörler de suçlanmaktadır. Kızlarda EP ile obezite prevalansının artması arasında korelasyon gösterilmiştir. Fazla kilolu ve obez çocukların, genellikle büyümede ve seksüel maturasyonda hızlanma ile birlikte ileri kemik yaşına (KY) sahip olduğu bildirilmiştir. Çalışmamızda, meme gelişimi ile başvuran ve EP açısından tetkik edilen obez ve obez olmayan kız çocuklarının klinik, laboratuvar ve radyolojik bulgularını karşılaştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya 3-8 yaş aralığında, meme dokusu nedeniyle çocuk endokrin polikliniğine başvuran ve EP ayırıcı tanısı için gonadotropin salgılatıcı hormon (GnRH) uyarı testi yapılan 50 obez ve fazla kilolu, 50 normal kilolu kız olgu alındı. Olguların takvim yaşı (TY), vücut ağırlığı standart deviasyon skoru (SDS), boy SDS, KY, KY-TY farkı (ΔKY-TY), bazal ve uyarılmış folikül stimülan hormon (FSH), luteinizan hormon (LH), östradiol, pik LH/FSH oranı, pelvik ultrasonla değerlendirilen uterus uzun çapı, uterus ve over volümleri kaydedildi.
Bulgular: Obez ve fazla kilolu olguların, boy SDS ve ΔKY-TY değerleri istatistiksel olarak anlamlı yüksek (sırasıyla p=0.001 ve p=0.02), KY istatistiksel olarak anlamlıya yakın yüksek bulundu (p=0.05). Obez olmayan olgularda bazal FSH değeri anlamlı yüksek saptandı (p=0.03). GnRH test yanıtlarında, Santral EP (SEP) tanı oranı obez olmayan olgularda (%26), obez olgulara (%16) göre daha yüksek saptandı, iki grup arasında anlamlı fark yoktu.
Sonuç: Obez olgularda, Boy SDS ve ΔKY-TY değerlerini daha yüksek ancak SEP tanı oranını düşük saptadık. Obez kızlarda kompensatuar hiperinsülinemi, insülin direnci, endokrin bozucular ve androjenler gibi altta yatan mekanizmalar, KY ilerlemesine ve pubertal karakteristik değişikliklere katkıda bulunarak SEP öngörüsünde yanıltıcı olabilir.

Keywords

Erken puberte, kız çocuk, obezite

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