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

Şervan Özalkak , Melikşah Keskin , Gülin Karacan , Şenay Savaş Erdeve , Semra Çetinkaya

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.

Keywords

GNRH analog tedavisi, Santral puberte prekoks, Vücut kitle indeksi, bel çevresi

Supporting Institution

yok

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

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.

Keywords

GNRH Analogue Treatment, Central Precocious Puberty, bady mass index, waist circumference

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.