Chonnam Med J.  2012 Apr;48(1):27-31. 10.4068/cmj.2012.48.1.27.

Effects of Gonadotropin-Releasing Hormone Agonist Therapy on Body Mass Index and Height in Girls with Central Precocious Puberty

• Lee SJ
• Yang EM
• Seo JY
• Kim CJ

• KMID: 2274878
• DOI: http://doi.org/10.4068/cmj.2012.48.1.27

Abstract

Treatment with gonadotropin-releasing hormone (GnRH) agonist is the treatment of choice for central precocious puberty (CPP). Many of the previous studies concerning the auxological effects of treatment with GnRH agonist in CPP have focused on final height. Much less attention has been paid to changes in body weight. However, concerns have been expressed that CPP may be associated with increased body mass index (BMI) both at initial presentation and during GnRH agonist treatment. We retrospectively reviewed the height and BMI of 38 girls with CPP. All patients were treated with GnRH agonist over 18 months. The height standard deviation score (SDS) for chronological age was significantly decreased during GnRH agonist treatment, whereas the height SDS for bone age was significantly increased. The predicted adult height was increased from 157.78+/-6.45 cm before treatment to 161.41+/-8.97 cm at 12 months after treatment. The BMI SDS for chronological age was significantly increased during treatment. The BMI SDS of normal-weight girls increased more than did the BMI SDS of overweight girls, but the increase was not significant. Preventive measures, such as increased physical activity, can be introduced to minimize possible alterations in body weight, and a long-term follow-up study is required to elucidate whether GnRH agonist treatment in Korean girls with CPP affects adult obesity.

Keyword

Precocious puberty; Obesity; Gonadotropin-releasing hormone

MeSH Terms

Adult
Body Mass Index
Body Weight
Follow-Up Studies
Gonadotropin-Releasing Hormone
Humans
Motor Activity
Obesity
Overweight
Piperazines
Puberty, Precocious
Retrospective Studies
Gonadotropin-Releasing Hormone
Piperazines

Figure

• 

  FIG. 1 Changes in the height SDS and BMI SDS for chronological age during GnRH agonist treatment. *p< 0.05 compared to before treatment. BMI: body mass index, HT: height, SDS: standard deviation score, CA: chronological age.

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  FIG. 2 Changes in the height SDS and BMI SDS for bone age during GnRH agonist treatment. *p<0.05 compared to before treatment. BMI: body mass index, HT: height, SDS: standard deviation score, BA: bone age.

Reference

1. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969. 44:291–303.

2. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update. 2004. 10:135–147.

3. Kauli R, Galatzer A, Kornreich L, Lazar L, Pertzelan A, Laron Z. Final height of girls with central precocious puberty, untreated versus treated with cyproterone acetate or GnRH analogue. A comparative study with re-evaluation of predictions by the Bayley-Pinneau method. Horm Res. 1997. 47:54–61.

4. Dunger DB, Ahmed ML, Ong KK. Effects of obesity on growth and puberty. Best Pract Res Clin Endocrinol Metab. 2005. 19:375–390.

5. Karlberg J. Secular trends in pubertal development. Horm Res. 2002. 57:Suppl 2. 19–30.

6. Troiano RP, Flegal KM. Overweight prevalence among youth in the United States: why so many different numbers? Int J Obes Relat Metab Disord. 1999. 23:Suppl 2. S22–S27.

7. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006. 295:1549–1555.

8. Carel JC, Roger M, Ispas S, Tondu F, Lahlou N, Blumberg J, et al. Final height after long-term treatment with triptorelin slow release for central precocious puberty: importance of statural growth after interruption of treatment. French study group of Decapeptyl in Precocious Puberty. J Clin Endocrinol Metab. 1999. 84:1973–1978.

9. Feuillan PP, Jones JV, Barnes K, Oerter-Klein K, Cutler GB Jr. 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. 84:44–49.

10. Arrigo T, De Luca F, Antoniazzi F, Galluzzi F, Segni M, Rosano M, et al. Reduction of baseline body mass index under gonadotropin-suppressive therapy in girls with idiopathic precocious puberty. Eur J Endocrinol. 2004. 150:533–537.

11. Lebrethon MC, Bourguignon JP. Management of central isosexual precocity: diagnosis, treatment, outcome. Curr Opin Pediatr. 2000. 12:394–399.

12. Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 1959. 2nd ed. Stanford: Stanford University Press.

13. 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.

14. Mogensen SS, Aksglaede L, Mouritsen A, Sørensen K, Main KM, Gideon P, et al. Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. J Clin Endocrinol Metab. 2011. 96:1393–1401.

15. Kim HK, Kee SJ, Seo JY, Yang EM, Chae HJ, Kim CJ. Gonadotropin-releasing hormone stimulation test for precocious puberty. Korean J Lab Med. 2011. 31:244–249.

16. Mul D, Hughes IA. The use of GnRH agonists in precocious puberty. Eur J Endocrinol. 2008. 159:Suppl 1. S3–S8.

17. Klein KO, Barnes KM, Jones JV, Feuillan PP, Cutler GB Jr. Increased final height in precocious puberty after long-term treatment with LHRH agonists: the National Institutes of Health experience. J Clin Endocrinol Metab. 2001. 86:4711–4716.

18. Heger S, Partsch CJ, Sippell WG. Long-term outcome after depot gonadotropin-releasing hormone agonist treatment of central precocious puberty: final height, body proportions, body composition, bone mineral density, and reproductive function. J Clin Endocrinol Metab. 1999. 84:4583–4590.

19. 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. 89:103–107.

20. 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. 83:370–373.

21. Oostdijk W, Rikken B, Schreuder S, Otten B, Odink R, Rouwé C, et al. Final height in central precocious puberty after long term treatment with a slow release GnRH agonist. Arch Dis Child. 1996. 75:292–297.

22. Palmert MR, Mansfield MJ, Crowley WF Jr, Crigler JF Jr, 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. 84:4480–4488.

23. 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. 19:1327–1334.