ESPE Abstracts

Background: Recent studies suggest an association between the Klotho protein, sex hormones, and insulin-like growth factor-1 (IGF-1). Particularly, considering the intricate interplay among α-Klotho, sex hormones, and IGF-1 during puberty, investigating α-Klotho levels in patients with central precocious puberty (CPP) could provide a deeper understanding of the significance of this protein.

Methods: A total of 210 pediatric participants were enrolled in this study, consisting of 120 patients diagnosed with central precocious puberty (CPP) (82 females and 38 males) and 90 healthy prepubertal controls (57 females and 33 males). From March 2020 to December 2023, we evaluated α-Klotho levels and clinical parameters. α-Klotho concentrations were measured using a Klotho ELISA kit. We additionally analyzed samples taken 6 months after GnRH agonist treatment. Result: In girls with CPP, α-Klotho levels were significantly elevated compared to the control group (CPP group: 2529 ± 999 pg/mL; control group: 1802 ± 675 pg/mL; P < 0.001), and they decreased significantly after six months of GnRH agonist treatment (2147 ± 789 pg/mL; P < 0.001). However, in boys with CPP, α-Klotho levels did not exhibit a significant difference compared to controls (CPP group: 2102 ± 1007 pg/mL; control group: 1818 ± 882 pg/mL; P = 0.506), and there was no significant change post-treatment (2047 ± 882 pg/mL; P = 0.557). The association between a-Klotho and IGF-1 SDS, baseline follicular stimulating hormone and baseline luteinizing hormone was assessed by partial correlation after adjusting for age, BMI SDS. Receiver operating characteristic curve analysis identified a meaningful α-Klotho cut-off for distinguishing girls with CPP from controls (area under the curve: 0.723).

Conclusion: Our study findings suggest that α-Klotho may serve as a promising biomarker for diagnosing CPP and monitoring treatment response in girls; however, its utility in boys appears limited. Further research is warranted to elucidate the gender-specific role of α-Klotho in pubertal development and its clinical implications.