Evaluation of the Clinical Characteristics of the Girls with Central Precocious Puberty at Diagnosis and During Treatment

Yıl 2019, , 358 - 362, 23.09.2019

Özlem Kara

https://doi.org/10.12956/tchd.581289

Öz

Aim: It is aimed to evaluate
the anthropometric and clinical characteristics of the girls with idiopathic
central precocius puberty (CPP) at diagnosis, during and at the end of
treatment.  

Materials and methods: Sixty-one girls who were diagnosed with CPP and
treated between January 2015 and December 2018 were included in the study. The
anthropometric, clinical characteristics and laboratory test results at
diagnosis, during and at the end of treatment were retrospectively evaluated.

Results: Mean age of the patients at diagnosis was 8.7±0.6 years,
bone age was 10.3±1.3 years, target height was 158.4±5.2 cm and predicted
height was 160.1±7.6 cm. While 18 (30%) patients presented with isolated
thelarche, 11 (18%) patients presented with menarche. At diagnosis, 28% of the
patients were obese and 25% were overweight. The average treatment period was 2
years. The body mass index (BMI) increased during treatment (p<0.001) which
was significant especially in the first two years of treatment (p<0.001). In
first year of treatment, the ratio of the obese patients had increased to 36%.
During treatment, height growth rates were decreased (p=0.02). However, the
predicted height at the end of the study was 160.1±6.2 cm and there was no
difference when compared to the height at diagnosis (p>0.05).

Conclusion: Obese and overweight girls should be followed up for
pubertal development. Awareness level of primary care physicians and
pediatricians should be increased in order to identify the early puberty
findings and provide appropriate guidance.

Anahtar Kelimeler

Awareness, idiopathic, menarche, obesity, precocious puberty

Kaynakça

• Sorensen K, Mouritsen A, Aksglaede L, Hagen CP, et al. Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty. Horm Res Paediatr 2012;77(3):137-4
• Teilmann G, Pedersen CB, Jensen TK, et al. Prevalence and incidence of precocious pubertal development in Denmark: an epidemiologic study based on national registries. Pediatrics. 2005 Dec;116(6):1323-8
• Crowley WF Jr, Comite F, Vale W, Rivier J, Loriaux DL, Cutler GB Jr. Therapeutic use of pituitary desensitization with a long-acting LHRH agonist: a potential new treatment for idiopathic precocious puberty. J Clin Endocrinol Metab 1981;52:370–372
• Fuld K, Chi C, Neely EK. A randomized trial of 1- and 3-month depot leuprolide doses in the treatment of central precocious puberty. J Pediatr 2011;159(6):982-7
• Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR, ESPE-LWPES GnRH Anologs Consensus Conference Group. Consensus statement on the use of gonodotropin-releasing hormone analogs in the children. Pediatrics 2009;123:e752-62
• 6. Cassio A, Bal MO, Orsini LF, et al. Reproductive outcome in patients treated and not treated for idiopathic early puberty: long-term results of a randomized trial in adults. J Pediatr. 2006 Oct;149(4):532-6
• 7. Assa A, Weiss M, Aharoni D, et al. Evaluation of bone density in girls with precocious and early puberty during treatment with GnRH agonist. J Pediatr Endocrinol Metab. 2011;24(7-8):505-10
• Cruz JNZ, Rodríguez ID, NishimuraMeguro E et al. Change in body mass index among girls with precocious puberty under treatment. Arch Argent Pediatr 2016;114(2):143-146
• Chiocca E, Dati E, Baroncelli GI et al. Body Mass Index and Body Composition in Adolescents Treated with Gonadotropin-Releasing Hormone Analogue Triptorelin Depot for Central Precocious Puberty: Data at Near Final Height. Neuroendocrinology 2009;89:441–447
• Pasquino AM, Pucarelli I, Accardo F 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. January 2008, 93(1):190–195
• Palmert MR, Mansfield MJ, Crowley WF, et al. 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 Dec;84(12):4480-8
• Arrigo T, De Luca F, Antoniazzi F, Galluzzi F, et al. Reduction of baseline body mass index under gonadotropinsuppressive therapy in girls with idiopathic precocious puberty. Eur J Endocrinol 2004;150(4):533-7
• Neely EK, Eilson DM, Lee PA, Stene M, Hintz RL. Spontaneous serum gonodotropin concentrations in the evaluation of precocious puberty. J Pediatr 1995;127:47-52
• Kandemir N, Demirbilek H, Ozon A, Gonc N, Alikasifoglu A. GnRH stimulation test in precocious puberty;single sample is adequate for diagnosis and dose adjustment. Horm Res 2009;72:336
• Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in girls. Arc Dis Child 1969;44:291-303
• Nelly EK, Hintz RL, Wilson DM, et al. Normal ranges for immunochemiluminometric gonadotropin assays. J Pediatr 1995;127:40-46
• Arrigo T, Cisternino M, Galluzzi F, et al. When stop GnRH analog therapy:The experience of the Italian Study Group for physiopathology of puberty. J Pediatr Endocrinol Metab 2000;13:759-764
• Partsch C-J, Sippell WG, and German Decapeptyl Study Group. Treatment of central precocious puberty :Lessons from a 15 years prospective trial. J Pediatr Endocrinol Metab 2000;13:747-758
• Antoniazzi F, Arrigo T,Cisternino M, et al. End results in central precocious puberty with GnRH analog treatment: The data of the Italian Study Group for physiopathology of puberty. J Pediatr Endocrinol Metab 2000;13:773-780
• Tanner JM, Goldstein H, Whitehouse RH. Standards for children’s height at ages 2–9 years allowing for heights of parents. Arch Dis Child 1970;45:755–762
• Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2nd ed. Stanford, CA: Stanford University Press; 1959
• Bayley N, Pinneau SR. Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards. J Pediatr 1952;40:423–441
• Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003; 24: 668–93
• Lakshman R, Forouhi NG, Sharp SJ, et al. Early age at menarche associated with cardiovascular disease and mortality. J Clin Endocrinol Metab 2009; 94: 4953–60
• Prentice P, Viner RM. Pubertal timing and adult obesity and cardiometabolic risk in women and men: a systematic review and meta-analysis. Int J Obes (Lond) 2013; 37: 1036–43
• Willemsen RH, Elleri D, Williams RM, Ong KK, Dunger DB. Pros and cons of GnRHa treatment for early puberty in girls. Nat Rev Endocrinol 2014; 10: 352–63
• 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 Nov;19(11):1327-34
• 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 Feb;83(2):370-3
• Poomthavorn P, Suphasit R, Mahachoklertwattana P. Adult height, body mass index and time of menarche of girls with idiopathic central precocious puberty after gonadotropin-releasing hormone analogue treatment. Gynecological Endocrinology, August 2011; 27(8): 524–528