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Change in body mass index and insulin resistance after 1-year treatment with gonadotropin-releasing hormone agonists in girls with central precocious puberty

김재현|박진아
대한소아내분비학회 (Korean Society Of Pediatric Endocrinology)|2017.03|Annals of Pediatric Endocrinology & Metabolism|제22권 제1호|pp. 27-35|DOI http://doi.org/10.6065/apem.2017.22.1.27

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키워드

ObesityBody mass indexPrecocious pubertyInsulin resistanceGnRH agonist
주제분류소아과학

초록

Purpose: Gonadotropin-releasing hormone agonist (GnRHa) is used as a therapeutic agent for central precocious puberty (CPP); however, increased obesity may subsequently occur. This study compared body mass index (BMI) and insulin resistance during the first year of GnRHa treatment for CPP. Methods: Patient group included 83 girls (aged 7.0–8.9 years) with developed breasts and a peak luteinizing hormone level of ≥5 IU/L after GnRH stimulation. Control group included 48 prepubertal girls. BMI and insulin resistance-related indices (homeostasis model assessment of insulin resistance [HOMA-IR] and quantitative insulin sensitivity check index [QUICKI]) were used to compare the groups before treatment, and among the patient group before and after GnRHa treatment. Results: No statistical difference in BMI z-score was detected between the 2 groups before treatment. Fasting insulin and HOMA-IR were increased in the patient group; fasting glucose-to-insulin ratio and QUICKI were increased in the control group (all P<0.001). In normal-weight subjects in the patient group, BMI z-score was significantly increased during GnRHa treatment (-0.1±0.7 vs. 0.1±0.8, P<0.001), whereas HOMA-IR and QUICKI exhibited no differences. In overweight subjects in the patient group; BMI z-score and HOMA-IR were not significantly different, whereas QUICKI was significantly decreased during GnRHa treatment (0.35±0.03 vs. 0.33±0.02, P=0.044). Conclusion: Girls with CPP exhibited increased insulin resistance compared to the control group. During GnRHa treatment, normal-weight individuals showed increased BMI z-scores without increased insulin resistance; the overweight group demonstrated increased insulin resistance without significantly altered BMI z-scores. Long-term follow-up of BMI and insulin resistance changes in patients with CPP is required

Abstract

Purpose: Gonadotropin-releasing hormone agonist (GnRHa) is used as a therapeutic agent for central precocious puberty (CPP); however, increased obesity may subsequently occur. This study compared body mass index (BMI) and insulin resistance during the first year of GnRHa treatment for CPP. Methods: Patient group included 83 girls (aged 7.0–8.9 years) with developed breasts and a peak luteinizing hormone level of ≥5 IU/L after GnRH stimulation. Control group included 48 prepubertal girls. BMI and insulin resistance-related indices (homeostasis model assessment of insulin resistance [HOMA-IR] and quantitative insulin sensitivity check index [QUICKI]) were used to compare the groups before treatment, and among the patient group before and after GnRHa treatment. Results: No statistical difference in BMI z-score was detected between the 2 groups before treatment. Fasting insulin and HOMA-IR were increased in the patient group; fasting glucose-to-insulin ratio and QUICKI were increased in the control group (all P<0.001). In normal-weight subjects in the patient group, BMI z-score was significantly increased during GnRHa treatment (-0.1±0.7 vs. 0.1±0.8, P<0.001), whereas HOMA-IR and QUICKI exhibited no differences. In overweight subjects in the patient group; BMI z-score and HOMA-IR were not significantly different, whereas QUICKI was significantly decreased during GnRHa treatment (0.35±0.03 vs. 0.33±0.02, P=0.044). Conclusion: Girls with CPP exhibited increased insulin resistance compared to the control group. During GnRHa treatment, normal-weight individuals showed increased BMI z-scores without increased insulin resistance; the overweight group demonstrated increased insulin resistance without significantly altered BMI z-scores. Long-term follow-up of BMI and insulin resistance changes in patients with CPP is required

참고문헌 (30)

  1. Carel JC, "Clinical practice: precocious puberty", N Engl J Med, 358, pp.2366~2377 (2008)
  2. Parent AS, "The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration", Endocr Rev, 24, pp.668~693 (2003)
  3. Resende EA, "Assessment of basal and gonadotropinreleasing hormone-stimulated gonadotropins by immunochemiluminometric and immunofluorometric assays in normal children", J Clin Endocrinol Metab, 92, pp.1424~1429 (2007)
  4. Carel JC, "Consensus statement on the use of gonadotropin- releasing hormone analogs in children", Pediatrics, 123, pp.e752~e762 (2009)
  5. Guaraldi F, "Management of endocrine disease: Long-term outcomes of the treatment of central precocious puberty", Eur J Endocrinol, 174, pp.R79~R87 (2016)
  6. Gamba M, "Control of GnRH neuronal activity by metabolic factors: the role of leptin and insulin", Mol Cell Endocrinol, 254-255, pp.133~139 (2006)
  7. Remsberg KE, "Early menarche and the development of cardiovascular disease risk factors in adolescent girls: the Fels Longitudinal Study", J Clin Endocrinol Metab, 90, pp.2718~2724 (2005)
  8. Srinivasan SR, "Predictability of childhood adiposity and insulin for developing insulin resistance syndrome (syndrome X) in young adulthood: the Bogalusa Heart Study", Diabetes, 51, pp.204~209 (2002)
  9. Raitakari OT, "The role of insulin in clustering of serum lipids and blood pressure in children and adolescents. The Cardiovascular Risk in Young Finns Study", Diabetologia, 38, pp.1042~1050 (1995)
  10. Ibáñez L, "Metformin treatment to prevent early puberty in girls with precocious pubarche", J Clin Endocrinol Metab, 91, pp.2888~2891 (2006)
  11. DeFronzo RA, "Glucose clamp technique: a method for quantifying insulin secretion and resistance", Am J Physiol, 237, pp.E214~E223 (1979)
  12. Conwell LS, "Indexes of insulin resistance and secretion in obese children and adolescents: a validation study", Diabetes Care, 27, pp.314~319 (2004)
  13. Chemaitilly W, "Central precocious puberty following the diagnosis and treatment of paediatric cancer and central nervous system tumours: presentation and longterm outcomes", Clin Endocrinol (Oxf), 84, pp.361~371 (2016)
  14. Sørensen K, "Insulin sensitivity and lipid profiles in girls with central precocious puberty before and during gonadal suppression", J Clin Endocrinol Metab, 95, pp.3736~3744 (2010)
  15. Chiavaroli V, "GNRH analog therapy in girls with early puberty is associated with the achievement of predicted final height but also with increased risk of polycystic ovary syndrome", Eur J Endocrinol, 163, pp.55~62 (2010)
  16. Anık A, "Effect of gonadotropinreleasing hormone agonist therapy on body mass index and growth in girls with idiopathic central precocious puberty", Indian J Endocrinol Metab, 19, pp.267~271 (2015)
  17. Głab E, "Influence of GnRH analog therapy on body mass in central precocious puberty", Pediatr Endocrinol Diabetes Metab, 15, pp.7~11 (2009)
  18. Pasquino AM, "Long-term observation of 87 girls with idiopathic central precocious puberty treated with gonadotropinreleasing hormone analogs: impact on adult height, body mass index, bone mineral content, and reproductive function", J Clin Endocrinol Metab, 93, pp.190~195 (2008)
  19. Shiasi Arani K, "Gonadotropin-releasing hormone agonist therapy and obesity in girls", Int J Endocrinol Metab, 13, pp.e23085~ (2015)
  20. Wolters B, "Treatment with gonadotropinreleasing hormone analogues: different impact on body weight in normal-weight and overweight children", Horm Res Paediatr, 78, pp.304~311 (2012)
  21. 이승재, "Effects of Gonadotropin-Releasing Hormone Agonist Therapy on Body Mass Index and Height in Girls with Central Precocious Puberty", 전남의대학술지, 48(1), pp.27~31 (2012), 의과학연구소
  22. 윤주영, "특발성 진성 성조숙증 여아에서 1년간의 성선자극호르몬 방출호르몬 효능약제 치료 전후 비만도의 관계", Annals of Pediatirc Endocrinology & Metabolism, 16(3), pp.165~171 (2011), 대한소아내분비학회
  23. 문진수, "2007 한국 소아 청소년 성장도표 : 개발 과정과 전망", Korean Journal of Pediatrics, 51(1), pp.1~25 (2008), 대한소아과학회
  24. Tanner JW, "Assessment of skeletal maturity and prediction of adult height (TW3 method)" (2001), W.B. Saunders
  25. Sørensen K, "Serum IGF1 and insulin levels in girls with normal and precocious puberty", Eur J Endocrinol, 166, pp.903~910 (2012)
  26. Arrigo T, "Reduction of baseline body mass index under gonadotropin-suppressive therapy in girls with idiopathic precocious puberty", Eur J Endocrinol, 150, pp.533~537 (2004)
  27. Bandini LG, "Change in leptin, body composition and other hormones around menarche--a visual representation", Acta Paediatr, 97, pp.1454~1459 (2008)
  28. Round JM, "Hormonal factors in the development of differences in strength between boys and girls during adolescence: a longitudinal study", Ann Hum Biol, 26, pp.49~62 (1999)
  29. Klein KO, "Effect of obesity on estradiol level, and its relationship to leptin, bone maturation, and bone mineral density in children", J Clin Endocrinol Metab, 83, pp.3469~3475 (1998)
  30. 정소정, "Body mass index and body composition scaling to height in children and adolescent", Annals of Pediatirc Endocrinology & Metabolism, 20(3), pp.125~129 (2015), 대한소아내분비학회

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