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

Abstract

Background/Aim: In children with central precocious puberty (CPP), gonadotropin-releasing hormone (GnRH) analogue treatment has been associated with an increase in body mass index (BMI). We evaluated BMI and body composition in adolescents treated with GnRH analogue at their near final height to assess the long-term effects of therapy on these parameters. Patients and Methods: We studied 20 patients (14.8 ± 1.6 years; 17 females) previously treated with triptorelin depot for CPP (3.75 mg/28 days) from 8.1 ± 0.8 to 11.5 ± 0.8 years. 23 healthy adolescents with normal onset of puberty (14.7 ± 2.1 years, 19 females) were the controls. BMI and body composition (dual-energy x-ray absorptiometry) were assessed. Results: Patients reached their near adult height (–0.5 ± 1.1 standard deviation score (SDS)); the girls were menstruating and the majority (15/17) had regular cycles, the boys showed normal testicular function. BMI was unchanged from the start of GnRH analogue therapy (0.4 ± 1.0 SDS) to near adult height (0.2 ± 1.0 SDS, p = NS vs. 0). Total fat mass (TFM) was significantly increased (16,144 ± 8,065 g; controls 10,712.1 ± 4,120.4 g, p < 0.02); glucose homeostasis and lipid profile corresponded to reference ranges. Conclusions: GnRH analogue therapy did not show long-term detrimental effects on BMI, but it may increase TFM, suggesting that body composition should be monitored till adulthood.

Insulin Sensitivity and Lipid Profiles in Girls with Central Precocious Puberty before and during Gonadal Suppression

“…In accordance, prepubertal and pubertal insulin-sensitizing therapy has been associated with favorable effects on pubertal onset and progression and adiposity and adipocytokine profiles both during and after completion of puberty in girls at risk of early puberty (23,24,39). However, data on metabolic risk factors and body composition in girls previously treated with GnRHa are sparse and ambiguous (18,40). Thus, further studies are needed to accurately determine whether these metabolic alterations persist after discontinuation of GnRHa treatment and completion of pubertal maturation.…”

“…In addition, inhibition of pubertal progression by GnRH agonist (GnRHa) treatment is associated with a continuous gain in adiposity despite suppression of gonadotropin and gonadal hormone secretion in such girls (16,18). Thus, GnRHa treatment does not seem to reverse the adverse body compositional changes associated with early maturation.…”

Changes in Body Mass Index in Girls with Idiopathic Central Precocious Puberty under Gonadotropin-Releasing Hormone Analogue Therapy: The Spanish Registry

“…In effect, while some authors report that GnRHa treatment is associated with weight gain [8,9,13,14,15,16,17], one study showed an increase only in those patients that were normal weight at study onset [18]. Other studies report no relationship between GnRHa treatment and an increase in body mass index (BMI) [4,10,11,12,19,20,21], while two studies demonstrated a decrease in BMI with GnRHa treatment [22,23]. These inconsistent findings could be related to several reasons including (1) different study designs, although most studies are retrospective; (2) heterogeneous etiology, including both organic and idiopathic CPP; (3) different age range and weight statuses at the onset of GnRHa treatment, and (4) distinct treatment strategies and follow-up times.…”

Long-Term Outcomes of Patients with Central Precocious Puberty due to Hypothalamic Hamartoma after GnRHa Treatment: Anthropometric, Metabolic, and Reproductive Aspects

“…Therefore, the speculation that HH per se plays a potential role in the physiopathology of obesity is tempting, but there is no evidence to support it. Moreover, the increased percentage of total fat mass reported by some authors reinforces the unfavorable effect of GnRHa on BMI and body composition in patients with idiopathic CPP [26][27][28].…”