Longitudinal follow-up to near final height of auxological changes in girls with idiopathic central precocious puberty treated with gonadotropin-releasing hormone analog and grouped by pretreatment body mass index level

Abstract

Purpose Reported changes in body mass index (BMI) in central precocious puberty (CPP) during and after gonadotropin-releasing hormone analog (GnRHa) treatment are inconsistent. We, therefore, investigated auxological parameters in GnRHa-treated girls with idiopathic CPP (ICPP) until attainment of near final height (NFH). Methods From the medical records of 59 ICPP girls who attained NFH after GnRHa therapy, auxological changes were compared between overweight (BMI≥85th percentile) and normal-weight (BMI<85th percentile) groups. BMIs were changed into standard deviation scores (BMISDSs) for subject chronologic age (BMISDS-CA) and bone age (BMISDS-BA).Results The incidence of overweight including obesity was high at the start of therapy (35.6%). The predicted adult height (PAH) at start of therapy was significantly shorter than the midparental height (MPH), whereas PAH at end of therapy approached MPH, and NFH was greater than MPH. Height velocity (HV) in the overweight group was higher during GnRHa therapy than that in the normal-weight group, but those in the two groups were not different after therapy until NFH. Both BMISDS-CA and BMISDS-BA increased significantly during therapy, but both BMISDSs decreased significantly after therapy until NFH. At NFH, neither BMISDS was different from that at baseline. In the normal-weight group, both BMISDSs increased during therapy and were maintained until NFH. In the overweight group, neither BMISDS changed during therapy, but there was a decrease after therapy until NFH.Conclusions The different patterns of BMISDS change during and after GnRHa therapy until NFH between the 2 groups were related to the different HV during GnRHa therapy.

Increased final adult height by gonadotropin-releasing hormone agonist in girls with idiopathic central precocious puberty

“…A number of researchers have investigated FAHs after long-term treatment of children diagnosed with CPP. The majority of these authors reported that height gain, which is the difference between the FAH and the initial predicted adult height, was between 2.0 cm and 9.8 cm, similar to the results obtained in our study [ 6 , 7 , 15 – 21 ]. Most authors analyzed the adult height compared with PAH based on patients’ bone age before treatment.…”

An Approach to the Evaluation and Management of the Obese Child With Early Puberty

“…In the setting of CPP and early puberty, some [ 79 , 80 ] but not all [ 81-84 ] studies have reported that obese girls display more exaggerated BA advancement compared with nonobese girls. In one study by Park et al, in which BA was similarly advanced (2 years) in obese and nonobese girls, predicted adult height (PAH) was significantly lower than MPH in the nonobese group, while PAH and MPH were not significantly different in the obese group.…”

“…Both groups also showed significant improvement in PAH and height SDS for BA while on therapy, attaining near adult heights comparable to their MPH [ 89 ]. As noted above, Park et al also found that obese children improved their PAH while on GnRHa therapy and reached near final heights exceeding their MPH [ 81 ].…”

“…A small number of studies have reported increases [ 88 , 90-93 ] or decreases [ 94 ] in BMI SDS associated with use of GnRHa to treat girls with CPP. However, the majority of studies have shown no significant change [ 95 , 96 ], or transient increases [ 81 , 87 , 97-99 ] during treatment that decrease after termination of therapy. These studies and others have been reviewed by 2 different writing groups [ 36 , 86 ] with the overall conclusion being that BMI SDS before treatment and BMI after treatment at near adult height are not significantly different from each other [ 94 , 100-102 ]; that is, GnRHa therapy is not associated with long-term worsening of obesity among girls with CPP.…”

“…Thus, even if GnRHa use is not associated with increases in BMI SDS, there is a need for counseling and intervention regarding healthy diet and lifestyle for many children with CPP and their families. Given data indicating that some nonobese girls may also experience a transient increase in BMI SDS with initiation of GnRHa therapy, the need for lifestyle counseling may also be relevant to nonobese children with CPP to help ensure any increases do not persist posttreatment [ 81 , 84 , 89 , 95 , 101-104 ]. Long-term studies of treated girls with CPP provide reassurance that treatment is not associated with increased risk of obesity or poor metabolic outcomes [ 95 , 104 ].…”