Precocious Puberty is defined by the onset of pubertal development at an age 2-2,5 standard deviations earlier than the normal population. Central Precocious Puberty (CPP) is diagnosed when the hypothalamic-pituitary axis is activated. Gonadotropin-releasing hormone analogues (Gn-RH analogues) are the main treatment option, but sometimes controversial. Whether this treatment influences children's body mass index (BMI) and a different BMI progression is still unclear.
Aims: To evaluate the effect of Gn-RH analogues on the BMI of children (boys and girls) with CPP at the end and one year after treatment.
Methods: Cross-sectional and multicentric study from a National Standardized Digital Database, enrolled from eleven Pediatric Endocrine Departments in Portugal. Five years data collection was analyzed (January 2013 to December 2017). Statistical analysis was performed using SPSSTM 23.0 version. Patients were evaluated before, at the end and one year after Gn-RH analogues' treatment and divided into four groups according to their BMI standard deviation score (BMI-SDS): low weight (LW), normal weight (NW), overweight (OW) and obesity (OB).
Results: A total of 241 cases presented CPP (90,5% female) and 17,4% were under 6 years of age. Only the ones that undergone treatment with Gn-RH analogues were analysed (84%); from these 46,5% (n=94) concluded the treatment when normal puberty was attained and 32% (n=65) continued to be followed one year after. At diagnosis of CPP, 44,7% of the patients were NW; from these, 33,4% became OW/OB after treatment with Gn-RH analogues. This occured for 35% (P<0,001) of the NW girls' but this association was not significant for boys. A positive association between Gn-RH analogues and the prevalence of OW and OB (P<0,01) was found. Patients treated with monthly triptorelin were significantly more OW/OB compared to those on depot triptorelin (45,5% versus 29%, P<0,001). One year after treatment, 91,3% of the patients with NW remained with a similar weight. Moreover 25% of the patients that became OW/OB with Gn-RH analogues, returned to NW again (P<0,001).
Conclusions: The authors concluded that treatment of PPC with Gn-RH analogues, especially monthly triptorrelin, increases BMI in girls but not in boys. A significant percentage of patients, however returns to a NW status one year after treatment. We suggest that CPP treatment modality should be individualized according to BMI progression.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology