Changes in body composition and muscle strength in girls with idiopathic central precocious puberty during gonadotropin-releasing hormone agonist therapy

Year 2025, Volume: 8 Issue: 1, 63 - 69, 12.01.2025

Zeynep Donbaloğlu , Berna Singin , Ebru Barsal Çetiner , Aynur Bedel , Bilge Aydın Behram , Kürşat Çetin , Hale Tuhan , Mesut Parlak

https://doi.org/10.32322/jhsm.1557045

Abstract

Aims: Our objective is to explore changes in body fat distribution and muscle strength among a cohort of girls with idiopathic central precocious puberty (ICPP) undergoing the gonadotropin-releasing hormone analogs (GnRHa) therapy.
Methods: A total of 50 patients who were newly diagnosed with ICPP and treated with GnRHa were included in the study. Patients were investigated at baseline, 6th months and 12th months.
Results: Body-mass index (BMI) standard deviation score (SDS) was similar throughout the treatment duration. The percentage of body fat (PBF) increased from 24.2±5.1% at the beginning to 26.3±5.3% at the 6th month and to 27.7±5.43% at the 12th month (p<0.001). While lean body mass (LBM) increased during the treatment duration (p<0.001), there was a decrease in the LBM percentage in both the 6th month and 12th month (p=0.001, p=0.005). The change in PBF between 0 and 12 months was significantly higher in the group with PBF<97th percentile (p), with a median of 2.3 (3.3)%, compared to a median of 0.5 (0.5)% in the group with PBF>97th p (p=0.005).
Conclusion: Over the one-year duration of GnRHa treatment, no increase was observed in BMI SDS. While PBF increased, a decrease was noted in LBM percentage. Despite the decrease in LBM percentage, since LBM increased over the course of treatment, an increase in muscle strength was observed under GnRHa therapy. Additionally, the alteration in PBF during GnRHa treatment exhibited variations based on the initial PBF status.

Keywords

Central precocious puberty, GnRHa therapy, body composition, lean body mass, muscle strength

Ethical Statement

Approval was obtained from the Ethics Committee prior to the commencement of the study (protocol number: 70904504/179). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supporting Institution

n/a

Gonadotropin salgılatıcı hormon agonisti tedavisi sırasında idiyopatik santral erken ergenlik dönemindeki kızlarda vücut kompozisyonunda ve kas gücünde meydana gelen değişiklikler

Abstract

Amaçlar: Amacımız, gonadotropin salgılatıcı hormon analogları (GnRHa) tedavisi gören idiyopatik santral erken ergenlik (ICPP) hastası kızlardan oluşan bir kohortta vücut yağ dağılımı ve kas gücündeki değişiklikleri incelemektir.
Yöntemler: Çalışmaya yeni ICPP tanısı almış ve GnRHa ile tedavi edilen toplam 50 hasta dahil edildi. Hastalar başlangıçta, 6. ayda ve 12. ayda incelendi.
Sonuçlar: Vücut kitle indeksi (VKİ) standart sapma skoru (SDS) tedavi süresi boyunca benzerdi. Vücut yağ yüzdesi (PBF) başlangıçta %24,2±5,1'den 6. ayda %26,3±5,3'e ve 12. ayda %27,7±5,43'e yükseldi (p<0,001). Tedavi süresi boyunca yağsız vücut kütlesi (LBM) artarken (p<0,001), hem 6. ayda hem de 12. ayda LBM yüzdesinde azalma görüldü (p=0,001, p=0,005). 0 ile 12 ay arasındaki PBF'deki değişim, PBF<97. persentil olan grupta anlamlı şekilde daha yüksekti (p), medyan %2,3 (3,3) iken, PBF>97. p olan grupta medyan %0,5 (0,5) idi (p=0,005).
Sonuç: GnRHa tedavisinin bir yıllık süresi boyunca, BMI SDS'de artış gözlenmedi. PBF artarken, LBM yüzdesinde bir azalma kaydedildi. LBM yüzdesindeki azalmaya rağmen, LBM tedavi süresince arttığından, GnRHa tedavisi altında kas gücünde bir artış gözlendi. Ayrıca, GnRHa tedavisi sırasında PBF'deki değişim, başlangıç ​​PBF durumuna bağlı olarak farklılıklar gösterdi.

Keywords

Merkezi erken ergenlik, GnRHa tedavisi, vücut kompozisyonu, yağsız vücut kütlesi, kas gücü

References

• Siervogel RM, Demerath EW, Schubert C, et al. Puberty and body composition. Horm Res. 2003;60(Suppl 1):36-45.
• Antoniazzi F, Zamboni G. Central precocious puberty: current treatment options. Paediatr Drugs. 2004;6(4):211-231.
• Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123(4):e752-e762.
• Donbaloğlu Z, Bedel A, Çetiner EB, et al. Effects of the gonadotropin-releasing hormone agonist therapy on growth and body mass index in girls with idiopathic central precocious puberty. Acta Endocrinol (Buchar). 2022;18(2):181-186.
• Gatt I, Smith-Moore S, Steggles C, Loosemore M. The takei handheld dynamometer: An effective clinical outcome measure tool for hand and wrist function in boxing. Hand. 2018;13(3):319-324.
• Kurtoglu S, Mazicioglu MM, Özturk A, Hatipoglu N, Cicek B, Ustunbas HB. Body fat reference curves for healthy Turkish children and adolescents. Eur J Pediatr. 2010;169(11):1329-1335.
• Neyzi O, Bundak R, Gökçay G, et al. Reference values for weight, height, head circumference, and body-mass index in Turkish children. J Clin Res Pediatr Endocrinol. 2015;7(4):280-293.
• Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Childhood. 1969;44(235):291-303.
• Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2nd ed. Stanford (CA): Stanford University Press; 1959;50-250.
• Bayley N, Pinneau SR. Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards. J Pediatr. 1952;40(4):423-441.
• Roche AF, Wainer H, Thissen D. The RWT method for the prediction of adult stature. Pediatrics. 1975;56(6):1027-1033.
• Guo SS, Chumlea WC, Roche AF, Siervogel RM. Age- and maturity-related changes in body composition during adolescence into adulthood: the Fels longitudinal study. Int J Obes Relat Metab Disord. 1997;21(12):1167-75.
• Warner JT, Cowan FJ, Dunstan FD, Gregory JW. The validity of body mass index for the assessment of adiposity in children with disease states. Ann Hum Biol. 1997;24(3):209-215.
• Lazarus R, Baur L, Webb K, Blyth F. Body mass index in screening for adiposity in children and adolescents: systematic evaluation using receiver operating characteristic curves. Am J Clin Nutr. 1996;63(4):500-506.
• Bereket A. A critical appraisal of the effect of gonadotropin-releasing hormon analog treatment on adult height of girls with central precocious puberty. J Clin Res Pediatr Endocrinol. 2017; 9(Suppl 2):33-48.
• Weise M, Flor A, Barnes KM, Cutler GB Jr, Baron J. Determinants of growth during gonadotropin-releasing hormone analog therapy for precocious puberty. J Clin Endocrinol Metab. 2004; 89(1):103-107.
• Palmert MR, Mansfield MJ, Crowley Jr WF, Crigler Jr JF, Crawford JD, Boepple PA. Is obesity an outcome of gonadotropin-releasing hormone agonist administration? Analysis of growth and body composition in 110 patients with central precocious puberty. J Clin Endocrinol Metab. 1999;84(12):4480-4488.
• Boot AM, De Muinck Keizer-Schrama S, Pols HA, Krenning EP, Drop SL. Bone mineral density and body composition before and during treatment with gonadotropin-releasing hormone agonist in children with central precocious and early puberty. J Clin Endocrinol Metab. 1998;83(2):370-373.
• Siervogel RM, Maynard LM, Wisemandle WA, et al. Annual changes in total body fat and fat-free mass in children from 8 to 18 years in relation to changes in body-mass index. The Fels longitudinal study. Ann N Y Acad Sci. 2000;904:420-423.
• 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(2):506-512.
• Wacharasindhu S, Petwijit T, Aroonparkmongkol S, Srivuthana S, Kingpetch K. Bone mineral density and body composition in Thai precocious puberty girls treated with GnRH agonist. J Med Assoc Thai. 2006;89(8):1194-1198.
• 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 Metab. 2000; 13(Suppl 1):791-794.
• Kamp GA, Manasco PK, Barnes KM, et al. Low growth hormone levels are related to increased body mass index and do not reflect impaired growth in luteinizing hormone-releasing hormone agonist-treated children with precocious puberty. J Clin Endocrinol Metab. 1991;72(2):301-307.
• Mansfield MJ, Rudlin CR, Crigler JF Jr, et al. Changes in growth and serum growth hormone and plasma somatomedin-C levels during suppression of gonadal sex steroid secretion in girls with central precocious puberty. J Clin Endocrinol Metab. 1988;66(1): 3-9.
• Arrigo T, De Luca F, Antoniazzi F, et al. Reduction of baseline body mass index under gonadotropin-suppressive therapy in girls with idiopathic precocious puberty. Eur J Endocrinol. 2004; 150(4):533-537.
• Lebrethon MC, Bourguignon JP. Management of central isosexual precocity: diagnosis, treatment, outcome. Curr Opin Pediatr. 2000;12(4):394-399.
• Lee SJ, Yang EM, Seo JY, Kim CJ. Effects of gonadotropin-releasing hormone agonist therapy on body mass index and height in girls with central precocious puberty. Chonnam Med J. 2012;48(1):27-31.
• Feuillan PP, Jones JV, Barnes K, Oerter-Klein K, Cutler Jr GB. Reproductive axis after discontinuation of gonadotropin-releasing hormone analog treatment of girls with precocious puberty: long term follow-up comparing girls with hypothalamic hamartoma to those with idiopathic precocious puberty. J Clin Endocrinol Metab. 1999;84(1):44-49.
• Wolters B, Lass N, Reinehr T. Treatment with gonadotropin-releasing hormone analogues: different impact on body weight in normal-weight and overweight children. Horm Res Paediatr. 2012;78(5-6):304-311.
• Yang WJ, Ko KH, Lee KH, Hwang IT, Oh YJ. The different effects of gonadotropin-releasing hormone agonist therapy on body mass index and growth between normal-weight and overweight girls with central precocious puberty. Ann Pediatr Endocrinol Metab. 2017;22(1):49-54.
• Aguiar AL, Couto-Silva AC, Vicente EJ, Freitas IC, Cruz T, Adan L. Weight evolution in girls treated for idiopathic central precocious puberty with GnRH analogues. J Pediatr Endocrinol Metab. 2006;19(11):1327-1034.
• Foster DL, Nagatani S. Physiological perspectives on leptin as a regulator of reproduction: role in timing puberty. Biol Reprod. 1999;60(2):205-215.
• Palmert MR, Radovick S, Boepple PA. Leptin levels in children with central precocious puberty. J Clin Endocrinol Metab. 1998; 83(7):2260-2265.
• McMurray RG. Developmental exercise physiology. Med Amp Sci Sports Amp Exerc. 1996;28:1531.
• Philippou A, Maridaki M, Halapas A, Koutsilieris M. The role of the insulin-like growth factor 1 (IGF-1) in skeletal muscle physiology. In Vivo. 2007;21(1):45-54.
• Ozmun JC, Mikesky AE, Surburg PR. Neuromuscular adaptations following prepubescent strength training. Med Sci Sport Exer. 1994;26(4):510-514.
• Costa T, Murara P, Vancini RL, de Lira CAB, Andrade MS. Influence of biological maturity on the muscular strength of young male and female swimmers. J Hum Kinet. 2021;78:67-77.
• Beunen G, Malina RM. Growth and physical performance relative to timing of the adolescent spurt. Exerc Sport Sci Rev. 1988;16:503-540.