Öz
Giriş
Bu çalışmada puberte prekoks şikayetleri ile başvuran kız çocuklarının klinik özellikleri ve laboratuvar sonuçları yaş gruplarına göre karşılaştırıldı. GnRHa (gonadotropin salgılatıcı hormon analoğu) tedavisinin etkileri, tedavi edilen ve edilmeyen olguların antropometrik verileri ve öngörülen son boyları (ÖSB) hesaplanarak değerlendirildi.
Gereç ve Yöntem
Çalışmaya toplam 75 kız çocuğu dahil edildi. Olgular dört gruba ayrıldı; 5-8 yaş arasında tedavi başlananlar Grup 1’i, başlanmayanlar Grup 2’yi; 8-10 yaş arasında tedavi başlananlar Grup 3’ü, başlanmayanlar Grup 4’ü oluşturdu. Antropometrik veriler, puberte evreleri, kemik yaşı (KY), KY’nın takvim yaşına (TY) oranındaki değişim (KY/TY) ve takip sırasında ÖSB’deki değişiklikler analiz edildi. Hedef Boy (HB) - ÖSB değişiklikleri tedavi edilen ve edilmeyen gruplarda karşılaştırıldı.
Bulgular
Başvuru sırasındaki boy, boy-SDS, VKI, VKI-SDS, ÖSB, HB, HB - ÖSB değerleri ve pubertal gelişim evreleri Grup 1 ve Grup 2 ile Grup 3 ve Grup 4 arasında benzerdi. İlk başvuru sırasında Grup 1 ve Grup 2’nin KY ve KY/TY değerleri benzerken, Grup 3’ün KY değeri Grup 4’e göre anlamlı derecede daha ileriydi. Başvuru sırasındaki KY/TY değerleri Grup 3 ve 4 arasında benzerdi. Takip sırasında boy, boy-SDS, VKI, VKI-SDS, KY ve KY/TY değişiklikleri benzerdi ve HB - ÖSB değerleri tedavi edilen ve edilmeyen gruplarda benzerdi.
Sonuç
Yaş gruplarına göre, ΔKY/ΔTY, HB - ÖSB, ΔVKI-SDS değerleri tedavi edilen ve edilmeyen olgular arasında benzerdi ve GnRHa tedavisinin olgu grubumuzda takip sırasında boy ve kilo üzerinde anlamlı bir etkisi yoktu.
Anahtar Kelimeler: Anahtar kelimeler: Puberte prekoks, GnRHa tedavisi, öngörülen son boy
Kaynakça
Zevin EL, Eugster EA. Central precocious puberty: a review of diagnosis, treatment, and outcomes. Lancet Child Adolesc Health. 2023;7:886-96.
Huang B, Biro FM, Dorn LD. Determination of relative timing of pubertal maturation through ordinal logistic modeling: evaluation of growth and timing parameters. J Adolesc Health. 2009;45:383-8.
Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR; ESPE-LWPES GnRH Analogs Consensus Conference Group, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123:e752-62.
Banerjee S, Bajpai A. Precocious puberty. Indian J Pediatr. 2023;90:582-9.
Kaplowitz PB, Oberfield SE. Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society. Pediatrics. 1999;104:936-41.
Biro FM, McMahon RP, Striegel-Moore R, Crawford PB, Obarzanek E, Morrison JA, et al. Impact of timing of pubertal maturation on growth in black and white female adolescents: The National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2001;138:636-43.
Cemeroglu AP, Kaval D, Ozcan O. Etiology of increased referrals for evaluation of early puberty in a tertiary care center in Turkey: true precocious puberty, obesity, or parental anxiety and lack of knowledge? Glob Pediatr Health. 2021;8:2333794X211009096.
Bangalore Krishna K, Klein KO, Eugster EA. Treatment of central precocious puberty with a focus on girls. Endocrinol Metab Clin North Am. 2024;53:229-38.
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;9:33-48.
Bar A, Linder B, Sobel EH, Saenger P, DiMartino-Nardi J. Bayley-Pinneau method of height prediction in girls with central precocious puberty: correlation with adult height. J Pediatr. 1995;126:955-8.
Frisch RE, Revelle R. Height and weight at menarche and a hypothesis of critical body weights and adolescent events. Science. 1970;169:397-9.
Frisch RE, Revelle R. The height and weight of girls and boys at the time of initiation of the adolescent growth spurt in height and weight and the relationship to menarche. Hum Biol. 1971;43:140-59.
Kanbur NO, Derman O, Kinik E. Prevalence of obesity in adolescents and the impact of sexual maturation stage on body mass index in obese adolescents. Int J Adolesc Med Health. 2002;14:61-5.
Rosenfield RL, Lipton RB, Drum ML. Thelarche, pubarche, and menarche attainment in children with normal and elevated body mass index. Pediatrics. 2009;123:84-8.
Traggiai C, Perucchin PP, Zerbini K, Gastaldi R, De Biasio P, Lorini R. Outcome after depot gonadotrophin-releasing hormone agonist treatment for central precocious puberty: effects on body mass index and final height. Eur J Endocrinol. 2005;153:463-4.
Chieldmetrics. Accessed on June 15, 2017. Available from: www.ceddcozum.com
Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969;44:291-303.
Hümmelink R, Oostdijk W, Partsch CJ, Odink RJ, Drop SL, Sippell WG. Growth, bone maturation and height prediction after three years of therapy with the slow release GnRH-agonist Decapeptyl-Depot in children with central precocious puberty. Horm Metab Res. 1992;24:122-6.
Magiakou MA, Manousaki D, Papadaki M, Hadjidakis D, Levidou G, Vakaki M, et al. The efficacy and safety of gonadotropin-releasing hormone analog treatment in childhood and adolescence: a single center, long-term follow-up study. J Clin Endocrinol Metab. 2010;95:109-17.
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.
Kletter GB, Kelch RP. Clinical review 60: effects of gonadotropin-releasing hormone analog therapy on adult stature in precocious puberty. J Clin Endocrinol Metab. 1994;79:331-4.
Głąb E, Wikiera B, Bieniasz J, Barg E. The influence of GnRH analog therapy on growth in central precocious puberty. Adv Clin Exp Med. 2016;25:27-32.
Franzini IA, Yamamoto FM, Bolfi F, Antonini SR, Nunes-Nogueira VS. GnRH analog is ineffective in increasing adult height in girls with puberty onset after 7 years of age: a systematic review and meta-analysis. Eur J Endocrinol. 2018;179:381-90.
Lazar L, Padoa A, Phillip M. Growth pattern and final height after cessation of gonadotropin-suppressive therapy in girls with central sexual precocity. J Clin Endocrinol Metab. 2007;92:3483-9.
Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics. 2002;110:903-10.
Yesiltepe Mutlu G, Eviz E, Haliloglu B, Kirmizibekmez H, Dursun F, Ozalkak S, et al. The effects of the covid-19 pandemic on puberty: a cross-sectional, multicenter study from Turkey. Ital J Pediatr. 2022;48:144.
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;48:27-31.
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;78:304-11.
Brito VN, Latronico AC, Cukier P, Teles MG, Silveira LF, Arnhold IJ, et al. Factors determining normal adult height in girls with gonadotropin-dependent precocious puberty treated with depot gonadotropin-releasing hormone analogs. J Clin Endocrinol Metab. 2008;93:2662-9.
