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특발성 진성 성조숙증 여아에서 성선자극호르몬 방출호르몬 효능약제 치료 1년 후의 성장 변화: 호남지역 다기관 연구

Growth Changes after One Year of Gonadotropin-Releasing Hormone Agonist Treatment in Idiopathic True Precocious Puberty Girls: Multicenter Study in Honam Area

김은영|김민선|김종덕|김찬종|이대열|정성남|김은성
대한소아내분비학회 (Korean Society Of Pediatric Endocrinology)|2010.04|Annals of Pediatric Endocrinology & Metabolism|제15권 제1호|pp. 33-43

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키워드

Breast feedingVitamin D deficiencyAlkaline phosphataseRickets
주제분류소아과학

초록

목 적: 성조숙증에서 치료제로 사용되는 GnRHa는 성호르몬의 분비를 억제함으로써 빠른 사춘기의 진행과 골성숙을 억제시켜 최종성인키를 향상시킨다고 알려져 있다. 저자들은 특발성 진성 성조숙증 여아에서 GnRHa의 1년 투여효과를 알아보고자 하였다. 방 법: 2003년 1월부터 2007년 5월까지 특발성 진성 성조숙증으로 진단받고, GnRHa를 투여중인 여아 43명을 대상으로, 1년 치료 후의 성장 및 성호르몬 변화 등을 살펴보았다. 결 과: 1. 전체 환아들의 치료 후 연성장속도는 5.8±2.9 cm 이었다. 골연령과 역연령의 차이는 치료 전 2.4±1.2년에서, 치료 후 2.1±0.3년으로 감소되었으나 통계적인 의미는 없었다. 예측성인키는 치료 전 156.4±7.4 cm에서, 1년 후 157.7± 7.2 cm로 의미있는 증가를 보이지 않았다. 그러나 중간부모키와 예측성인키의 차(MPH-PAH)에 따라 구분했을 때, 중간부모키와 예측성인키의 차가 5 cm 이상이었던 군에서, 골연령에 대한 신장표준편차점수가 치료 전 -1.8±0.7에서 치료 후 -1.3±0.8로 증가되고, 예측성인키도 149.1±4.6 cm에서, 1년 치료 후 153.6±5.8 cm로 의미있게 증가되었다(4.5±4.4 cm 예측성인키 획득). 그리고 전체 환아에서 중간부모키와 예측성인키의 차가 클수록, 신장획득이 증가되었다(r=0.59, P˂0.01). 치료 1년 후 예측성인키의 증가는 치료 전 예측성인키, 골연령에 대한 신장표준편차점수와는 음의 상관관계(r= -0.42, P˂0.01 과 r=-0.38, P =0.01), 치료 전 골연령과는 양의 상관관계를 보였다(r=0.36, P˂0.05). GnRHa 투여 후 유방발달은 진행되지 않았고, 성선자극호르몬 및 estradiol은 잘 억제되었다. 체질량 지수와 체질량지수 백분위수는 GnRHa 치료 후에 증가되었다. 결 론: 중간부모키에 비해 예측성인키가 5 cm 이상 작았던 경우는 GnRHa 투여 후 신장획득이 뚜렷하였다. 그리고 성호르몬과 유방발달은 GnRHa에 의해 잘 억제되었다.

Abstract

Purpose: We evaluated the effects of treatment with gonadotropin-releasing hormone agonist (GnRHa) on growth and sex hormone changes in idiopathic true precocious puberty girls. Methods: From January 2003 through May 2007, forty-three female children, who were diagnosed as idiopathic true precocious puberty and were administered GnRHa for one year were enrolled in this retrospective study. We divided the patients into two groups according to midparental height (MPH) minus predicted adult height (PAH)(MPH-PAH≥5 cm, or MPH-PAH˂5 cm ). Results: In total patients, post-treatment yearly growth velocity was 5.8±2.9 cm. Bone age advancement did not decline (2.4±1.2 years before treatment, and 2.1±0.3 years after treatment), so significant difference was not found in PAH before and after treatment (156.4±7.4 cm vs. 157.7±7.2 cm). But in a group who showed MPH minus PAH was 5 cm or more (MPH-PAH≥5 cm), height standard deviation score for bone age (Ht SDS for BA) was significantly increased before and after treatment (-1.8±0.7 vs. -1.3±0.8). PAH after treatment was increased to 153.6±5.8 cm from 149.1±4.6 cm before treatment (PAH gain 4.5±4.4 cm). Furthermore, as MPH-PAH increased, so did PAH gain (r=0.59, P˂0.01). Height gain was positively correlated with bone age before treatment (r=0.36, P˂0.05) and negatively correlated with PAH before treatment (r=-0.42, P˂0.01), and Ht SDS for BA (r=-0.38, P=0.01) before treatment in total patients. The successful suppression of sex hormones and breast development were observed. The body mass index and body mass index percentile were increased after treatment. Conclusion: The girls who showed MPH minus PAH was 5cm or more (MPH-PAH≥5 cm) before treatment attained significant height gain with GnRHa administration. The successful gonadal suppression was also observed.

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