Santral erken puberteli hastalarda GNRH agonisti tedavisinin antropometrik ölçümlere etkisi

Abstract

Amaç: Çalışmamızda idiyopatik santral erken puberte (SEP) tanılı kız hastalarda Gonadotropin Releasing Hormone agonist (GnRHa) tedavisinin, antropometrik bulgular üzerindeki etkileri ve tedavinin öngörülen erişkin boya (ÖEB) etkisini değerlendirilmeyi amaçladık. Materyal ve metod: Çalışmaya Haziran 2013 – Aralık 2018 tarihleri arasında Pamukkale Üniversitesi Çocuk Endokrinoloji polikliniğine başvuran idiyopatik SEP tanısı ile takipli en az 2 yıldır GnRHa uygulanan hastalar alındı. Hastaların verileri, klinik, laboratuvar ve görüntüleme parametreleri hastane kayıtlarından incelenerek kaydedildi. Kemik yaşı (KY) BoneXpert® yazılımı ile dijital olarak değerlendirildi. Bulgular: Hastaların tanı esnasındaki yaş ortalaması 8.02 ± 1.07 yıldı. Ortalama takip süresi 2,23±0,47 yıl idi. Hastaların vücut ağırlık, vücut ağırlık SDS (standart sapma skoru), vücut kitle indeksi (VKİ) ve VKİ SDS’lerinde izlemlerde giderek arttığı görüldü. Tedavinin 6, 12, 18, 24. ay ve tedavi sonunda VKİ ve VKİ SDS değerlerindeki artış, tedavi başlangıç değerlerine göre istatistiksel olarak anlamlı idi. Tedavinin başlangıcında 23 (% 18.6) hasta aşırı kilolu ve 17 (% 13.8) hasta obez iken tedavinin sonunda 37 (% 30.0) hasta aşırı kilolu ve 26 (% 21.3) hasta obezdi. Normal kilolu hastalarda GnRHa tedavisi sonunda ortalama VKİ SDS değerinde tedavi başlangıcına göre anlamlı artış saptandı (p<0.05). Aşırı kilolu ve obez hastalarda tedavi sonundaki ortalama VKİ SDS değerinde tedavi başlangıcına göre azalma saptandı. Bu azalma istatistiksel olarak anlamlı değildi (p=0.706). Tedavi başlangıcı (160,91 ± 6,85) ile kıyaslandığında son izlemde (162,10 ± 6,17) hastaların ÖEB’sinde istatistiksel olarak anlamlı bir artış olduğu bulundu (p<0.05). Tedavi sonunda ortalama ÖEB’nin (162,10±6,17 cm), ortalama HB’yi (160,98±6,17 cm) geçtiği saptandı. Son izlemde boy SDS, KY SDS, KY/TY oranında, KY-TY farkında, tedavi başlangıç değerine göre istatistiksel olarak anlamlı azalma saptandı (p<0.05). YBH ve YHB SDS’sinin izlemlerde giderek azaldığı saptandı. Sonuç: GnRHa tedavisinin ÖEB’yi ve kilo alımını arttırdığı bulundu. GnRHa tedavisinin tedavi başlangıcında normal kilolu olan hastalarda kilo alımını arttırırken, aşırı kilolu ve obez hastalarda kilo azalmasına neden olduğu bulundu. Puberte başlangıcından erişkin döneme kadar izlemlerin yapıldığı ve hedef boya ulaşma durumunun gözlemlenebildiği daha kapsamlı ve uzun takip süreli çalışmalara ihtiyaç vardır.

Objective: the aim of study is to evaluate effects of Gonadotropin Releasing Hormone agonist(GnRHa) treatment on the antropometric findings of girls diagnosed with Idiopathic central precocious puberty . Materials and method: Patients who visited Pamukkale University Pediatric Endocrinology polyclinic diagnosed with idiopathic central precocious puberty and are followed with at least 2 years of recieving GnRH agonists were taken in to the study between the periods of June 2013 and December 2018. The data of the patients were analysed from the hospital’s records of the clinic,laboratory and imaging parameters. The bone age was digitally evaluated using BoneXpert® software. Results : During the diagnosis of the patients,the median age was 8.02 ± 1.07 years. The average follow up period was 2,23±0,47 years. The body weight, the Standard Deviation of the body weight, Body Mass Index(BMI) and the Standard Deviation of the Body Mass Index of the patients were found to increase progressively. The increment in the values of the Body Mass Index and the Standard Deviations of the Body Mass Index after 6,12,18 and 24 months of the treatment was found to be statistically significant compared to the values at the inception of the treatment. While at the onset of the treatment, 23 (18.6%) of the patients were overweight and 17 (13.8%) of the patients were obese, at the end of the study ,37 (30%) of the patients became overweight and 26 (21.3%) of the patients became obese. It was found that in patients with normal weight, the increase in the average Standard Deviations of the Body Mass index after treatment with GnRH agonists compared to that of the onset of the treatment was statistically significant (p<0.05). In morbidly obese and obese patients the average Standard Deviation of the Body Mass Index at the end of the treatment was found to decrease compared to that of the onset of the treatment. This decrement was not found to be statistically significant(p=0.706). When compared to the onset of treatment (160,91 ± 6,85), it was found that at the end of the follow up (162,10 ± 6,17) there was a statistically significant increment in the predicted adult height of the patients (p<0.05). At the end of the treatment,it was found out that the average predicted adult height(162,10±6,17 cm) has surpassed the average mid parental height (160,98±6,17 cm) of the patients. At the last follow up the standard deviation of the height,bone age, the ratio of the bone age to the chronological age,the differences between bone age and the chronological age ,when compared to the values at the onset of treatment, there was a statistically significant decrease (p<0.05). Upon follow up,it was found out that there was a progressive decrease in the growth velocity and the standard deviation of the growth velocity. Conclusion: It was found out that there was an increase in the predicted bone age and the body weight with the treatment of GnRH agonists. While at the onset of treatment, patients with normal weight eventually gained weight,patients that were morbidly obese and those that were obese were found have a decrease in weight with the treatment of GnRH agonists. There is a need for the conduction of more extensive and long duration studies from the onset of puberty to the period of adulthood where follows ups can be conducted and the state of the mid parental height being monitored.