Ann Pediatr Endocrinol Metab.  2020 Jun;25(2):92-96. 10.6065/apem.1938164.082.

Prevalence of idiopathic scoliosis in girls with central precocious puberty: effect of a gonadotropin-releasing hormone agonist

• Chung LY
• Nam HK
• Rhie YJ
• Huh R
• Lee KH

• KMID: 2503359
• DOI: http://doi.org/10.6065/apem.1938164.082

Abstract

Purpose
Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis and occurs in children between 10 to 18 years old, during periods of growth spurts and puberty changes. In patients with central precocious puberty (CPP), due to early growth spurt, AIS is expected to develop before 10 years of age. Both AIS and CPP are more common in girls than in boys. The aim of this study was to determine the prevalence of AIS in girls with CPP and to evaluate the effect of treatment with gonadotropin-releasing hormone (GnRH) agonists on progression of scoliosis in these patients.
Methods
We retrospectively reviewed medical records of 553 girls, 338 with CPP and 215 without CPP. Scoliosis angle was measured on the standing frontal radiograph of each patient according to the Cobb method. Patients with a Cobb angle of 10° or more were diagnosed with scoliosis. For girls with CPP, followup spine radiographs were collected 1 year after treatment with GnRH agonists. Progression of scoliosis before and after treatment was compared in terms of Cobb angle changes.
Results
AIS was more prevalent in girls that were affected by CPP compared to controls without CPP (11.5% vs. 6.0%, CPP girls vs. non-CPP girls, respectively, P=0.031). The peak serum luteinizing hormone level positively correlated with Cobb angle (R²=0.015, P=0.023) in the CPP group. No progression of scoliosis was observed in CPP girls after one year of GnRH agonist treatment. Additionally, the prevalence of scoliosis decreased in CPP girls after 1 year of the treatment.
Conclusion
We report that the prevalence of AIS is higher in girls with CPP than in non-CPP patients. A regular follow-up schedule for spine radiographs should be considered to reduce the risk of progression. Furthermore, GnRH agonist treatment for CPP may have a suppressive effect on progression of AIS.

Keyword

Central precocious puberty; Gonadotropin-releasing hormone agonist; adolescent idiopathic scoliosis; peak LH

Reference

References

1. Willner S, Uden A. A prospective prevalence study of scoliosis in Southern Sweden. Acta Orthop Scand. 1982; 53:233–7.

2. Roach JW. Adolescent idiopathic scoliosis. Orthop Clin North Am. 1999; 30:353–65. vii-viii.

3. Kamtsiuris P, Atzpodien K, Ellert U, Schlack R, Schlaud M. Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007; 50:686–700.

4. Suh SW, Modi HN, Yang JH, Hong JY. Idiopathic scoliosis in Korean schoolchildren: a prospective screening study of over 1 million children. Eur Spine J. 2011; 20:1087–94.

5. Dunn J, Henrikson NB, Morrison CC, Blasi PR, Nguyen M, Lin JS. Screening for adolescent idiopathic scoliosis: evidence report and systematic review for the US preventive services task force. JAMA. 2018; 319:173–87.

6. Goldstein LA, Waugh TR. Classification and terminology of scoliosis. Clin Orthop Relat Res. 1973; (93):10–22.

7. Sanders JO, Browne RH, McConnell SJ, Margraf SA, Cooney TE, Finegold DN. Maturity assessment and curve progression in girls with idiopathic scoliosis. J Bone Joint Surg Am. 2007; 89:64–73.

8. Reamy BV, Slakey JB. Adolescent idiopathic scoliosis: review and current concepts. Am Fam Physician. 2001; 64:111–6.

9. Little DG, Song KM, Katz D, Herring JA. Relationship of peak height velocity to other maturity indicators in idiopathic scoliosis in girls. J Bone Joint Surg Am. 2000; 82:685–93.

10. Kim SH, Huh K, Won S, Lee KW, Park MJ. A Significant increase in the incidence of central precocious puberty among Korean girls from 2004 to 2010. PLoS One. 2015; 10:e0141844.

11. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update. 2004; 10:135–47.

12. Cobb J. Outline for the study of scoliosis. Instr Course Lect AAOS. 1948; 5:261–75.

13. Somerville EW. Rotational lordosis; the development of single curve. J Bone Joint Surg Br. 1952; 34-B:421–7.

14. Le Febvre J, Triboulet-Chassevant A, Missirliu MF. Electromyographic data in idiopathic scoliosis. Arch Phys Med Rehabil. 1961; 42:710–1.

15. De George FV, Fisher RL. Idiopathic scoliosis: genetic and environmental aspects. J Med Genet. 1967; 4:251–7.

16. Goldberg CJ, Fogarty EE, Moore DP, Dowling FE. Scoliosis and developmental theory: adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 1997; 22:2228–37.

17. Burwell RG, Dangerfield PH, Moulton A, Grivas TB. Adolescent idiopathic scoliosis (AIS), environment, exposome and epigenetics: a molecular perspective of postnatal normal spinal growth and the etiopathogenesis of AIS with consideration of a network approach and possible implications for medical therapy. Scoliosis. 2011; 6:26.

18. Willner S. A study of growth in girls with adolescent idiopathic structural scoliosis. Clin Orthop Relat Res. 1974; (101):129–35.

19. Nordwall A, Willner S. A study of skeletal age and height in girls with idiopathic scoliosis. Clin Orthop Relat Res. 1975; (110):6–10.

20. Archer IA, Dickson RA. Stature and idiopathic scoliosis. A prospective study. J Bone Joint Surg Br. 1985; 67:185–8.

21. Konieczny MR, Senyurt H, Krauspe R. Epidemiology of adolescent idiopathic scoliosis. J Child Orthop. 2013; 7:3–9.

22. Wong HK, Hui JH, Rajan U, Chia HP. Idiopathic scoliosis in Singapore schoolchildren: a prevalence study 15 years into the screening program. Spine (Phila Pa 1976). 2005; 30:1188–96.

23. Kulis A, Goździalska A, Drąg J, Jaśkiewicz J, KnapikCzajka M, Lipik E, et al. Participation of sex hormones in multifactorial pathogenesis of adolescent idiopathic scoliosis. Int Orthop. 2015; 39:1227–36.

24. Brito VN, Batista MC, Borges MF, Latronico AC, Kohek MB, Thirone AC, et al. Diagnostic value of fluorometric assays in the evaluation of precocious puberty. J Clin Endocrinol Metab. 1999; 84:3539–44.

25. Burwell RG, Aujla RK, Grevitt MP, Dangerfield PH, Moulton A, Randell TL, et al. Pathogenesis of adolescent idiopathic scoliosis in girls - a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy. Scoliosis. 2009; 4:24.