성조숙증으로 진단된 여아에서 성선자극호르몬 방출호르몬 효능약제 치료 후 첫 3개월 성장속도가 1년 후 성장에 미치는 영향
Prediction of 1 Year Growth in Girls with Precocious Puberty with GnRH Agonist Treatment by Measurement of Growth Velocity at 3 Months after Treatment
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목 적:진성 성조숙증의 치료에 있어서 성선자극호르몬 방출호르몬 효능약제 (GnRH agonist)의 사용은 사춘기의 진행과 골성숙을 억제하여 최종 성인신장을 향상시킨다고 알려져 있다. 그러나 GnRH agonist의 투여 효과는 대상군에 따라 다양한 결과를 보인다. 또한 GnRH agonist 단독 치료 및 성장호르몬의 병용 치료를 비교했을 때 성장호르몬 병용투여가 골연령의 증가없이 예측 성인신장을 향상시킨다고 보고하였다. 따라서 본 연구에서는 진성 성조숙증 여아에서 GnRH agonist 치료 3개월 후의 성장속도로 치료 1년 후의 성장속도를 예측할 수 있는 지를 알아보고 이를 통해 성장호르몬의 병용 여부를 치료 초기에 결정할 수 있는 지를 확인하고자 하였다. 방 법:한림대학교 강동성심병원 소아청소년과에서 진성 성조숙증으로 진단받은 여아 중 진단 당시 연령이 9세 미만, 골연령이 11세 이하, 최소 1년간 성선자극호르몬 방출호르몬 효능약제(GnRH agonist)를 4주 간격으로 치료받았던 30명을 연구 대상에 포함시켰다. 성장호르몬을 병용투여한 환아는 대상에서 제외하였다. 자료수집은 외래차트를 통하여 이루어졌고 성장속도는 치료 3개월 후, 6개월 후, 9개월 후, 1년 후의 신장을 각각 연성장속도로 재계산하여 비교하였다. 결 과:대상 환아의 평균 연령은 8.3±0.8세, 평균 골연령은 10.4±0.6세였다. GnRH agonist 치료 3개월 후 평균 성장속도는 7.1±2.6 cm/년, 치료 1년 후 평균 성장속도는 5.8±0.9 cm/년이었다. GnRH agonist 치료 3개월 후 성장속도와 치료 1년 후 성장속도는 의미있는 양의 상관관계를 보였다(r=0.553, P=0.002). 결 론:본 연구에서 성선자극호르몬 방출호르몬 효능약제 치료 3개월 후의 성장속도가 1년 후의 성장속도와 양의 상관관계를 보이며 추후 장기적인 성장 평가 및 최종 성인신장과의 연관성 등에 대한 추가적인 연구가 필요할 것으로 생각된다.
Abstract
Purpose:The aim of this study was to assess the usefulness of growth velocity at 3 months after gonadotropin- releasing hormone (GnRH) agonist treatment as a predictive value of 1 year growth velocity after treatment in girls with precocious puberty. Methods: We studied 30 Korean girls with precocious puberty whose chronologic and bone age were less than 9 years and 11 years old, respectively at diagnosis. They treated with a 4 week interval GnRH agonist subcutaneous injections for at least more than 1 year. The patients who were treated with growth hormone simultaneously excluded for this study. Data were collected from chart review retrospectively. We measured heights and calculated growth velocities of the subjects at 3 months and 1 year after GnRH agonist treatment. Results: The mean chronologic age and bone age of the subjects were 8.3±0.8 year and 10.4±0.6 years, respectively. The growth velocity at 3 months, 6 months, 9 months and 1 year after GnRH agonist treatment were 7.1±2.6, 6.6±2.1, 5.7±1.3 and 5.8±0.9 cm/yr, respectively. The positive correlation between the growth velocity at 3 months and 6 months, 9 months, 1 year after GnRH agonist treatment were shown(P ˂0.001, P ˂0.001, P =0.002, respectively). Conclusion: In this study, the growth velocity at 1 year after GnRH agonist treatment may be predicted by the growth velocity at 3 months after treatment. The patient whose growth velocity at 3 months after GnRH agnoist treatment was low would be needed to observe the growth pattern carefully and to consider combined growth hormone treatment, if needed. It may be deserve further studies to improve final height in patients with central precocious puberty in various conditions.(J Korean Soc Pediatr Endocrinol 2011;16:80-85)
참고문헌 (20)
- Ritzén EM, "Early puberty: what is normal and when is treatment indicated", Horm Res, 60(3), pp.31~34 (2003)
- Ojeda SR, "Neuroendocrine mechanisms controlling female puberty: new approaches, new concepts", Int J Androl, 29, pp.256~263 (2006)
- Fontoura M, "Precocious puberty in girls: early diagnosis of a slowly progressing variant", Arch Dis Child, 64, pp.1170~1176 (1989)
- Ojeda SR, "New thoughts on female precocious puberty", J Pediatr Endocrinol Metab, 14, pp.245~256 (2001)
- Bertelloni S, "Effect of central precocious puberty and gonadotropin-releasing hormone analogue treatment on peak bone mass and final height in females", Eur J Pediatr, 157, pp.363~367 (1998)
- Shankar RR, "Precocious puberty", Adv Endocrinol Metab, 6, pp.55~89 (1995)
- Crowley WF Jr, "Therapeutic use of pituitary desensitization with a long-acting lhrh agonist: a potential new treatment for idiopathic precocious puberty", J Clin Endocrinol Metab, 52, pp.370~372 (1981)
- Attie KM, "The pubertal growth spurt in eight patients with true precocious puberty and growth hormone deficiency: evidence for a direct role of sex steroids", J Clin Endocrinol Metab, 71, pp.975~983 (1990)
- Paul D, "Long-term effect of gonadotropin-releasing hormone agonist therapy on final and near-final height in 26 children with true precocious puberty treated at a median age of less than 5 years", J Clin Endocrinol Metab, 80, pp.546~551 (1995)
- Oerter KE, "Adult height in precocious puberty after long-term treatment with deslorelin", J Clin Endocrinol Metab, 73, pp.1235~1240 (1991)
- Kauli R, "Final height of girls with central precocious puberty, untreated versus treated with cyproterone acetate or GnRH analogue. A comparative study with re-evaluation of predictions by the Bayley-Pinneau method", Horm Res, 47, pp.545~61 (1997)
- Cara JF, "Growth hormone deficiency impedes the rise in plasma insulin-like growth factor I levels associated with precocious puberty", J Pediatr, 115, pp.64~68 (1989)
- 서지영, "진성 성조숙증으로 진단 받은 여아에서 gonadotropin-releasing hormone agonist 단독치료 및 growth hormone의 병합치료 시 예측 성인키의 변화 및 성장 획득의 비교", Korean Journal of Pediatrics, 49(3), pp.305~311 (2006), 대한소아과학회
- Bayley N, "Tables for predicting adult height from skeletal age: revised for use with the Greulich-Pyle hand standards", J Pediatr, 40, pp.423~441 (1952)
- Greulich WW, "Radiographic atlas of skeletal development of the hand and wrist. 2nd ed" (1959), Stanford University Press
- Marshall WA, "Growth and physiological development during adolescence", Annu Rev Med, 19, pp.283~300 (1968)
- Klein KO, "Increased final height in precocious puberty after long-term treatment with LHRH agonists: the National Institutes of Health experience", J Clin Endocrinol Metab, 86, pp.4711~4716 (2001)
- Arrigo T, "Analysis of the factors affecting auxological response to GnRH agonist treatment and final height outcome in girls with idiopathic central precocious puberty", Eur J Endocrinol, 141, pp.140~144 (1999)
- Toumba M, "Efficacy of combined treatment with growth hormone and gonadotropin releasing hormone analogue in children with poor prognosis of adult height", Indian Pediatr, 44, pp.497~502 (2007)
- 황진순, "성조숙증 여아에서 성선자극호르몬방출호르몬유도체 단독 치료와 성장호르몬 병합 치료가 예측성인신장에 미치는 영향", 대한소아내분비학회지, 12(2), pp.111~118 (2007), 대한소아내분비학회