Evaluation of the characteristics and treatment results of patients with precocious puberty

Introduction-Aim: Precocious puberty is a common problem in pediatric endocrinology outpatient clinics. In recent studies, it is reported that the number of cases admitted to the pediatric endocrinology outpatient clinic with the complaints of precocious puberty in the world and in our country has increased. In this study; it was aimed to obtain the first regional data by evaluating the anthropometric and clinical findings of the treatment during gonadotropin-releasing hormone analogue (GnRHa) treatment and the effects of the treatment on height gain and body mass index, as well as the role of luteinizing hormone-releasing hormone stimulation (LHRH) test in diagnosis of patients who presented with early puberty symptoms and were diagnosed with central precocious puberty (CPP). Material-Method: This study was done by examining the files of the patients who applied to Karadeniz Technical University Medical Faculty Pediatric Endocrinology Department between 2009-2019 with the complaint of precocious puberty. The data of girls under eight years of age and boys under nine years of age who presented with early puberty symptoms or who had an advanced puberty stage according to their age, with basal serum luteinizing hormone, in female patients with high basal serum estradiol, in male cases with high basal serum testosterone levels or the result of LHRH stimulation test compatible with CPP of patients who were followed up and treated for at least six months in our Pediatric Endocrinology Department, were included in the study. Patients with incomplete early puberty or those with early puberty or a chronic disease were excluded. The diagnosis of CPP was accepted as the thelarche is ≥stage 2 in female patients under the age of eight, and the testicular volume is ≥4 ml in male patients under the age of nine; basal LH value ≥0.2 mIU/mL and/or stimulated LH value ≥5 mIU/mL and bone age (BA)/chronological age (CA) >1.2 of patients. Anthropometric, clinical and laboratory findings were evaluated in our CPP cases. Results: Of our 522 cases admitted with early puberty symptoms, 85% (n=443) were boys and 15% (n=79) were girls and 37.9% (n = 198) of these cases were precocious puberty. In precocious puberty cases, the percentage of CPP was 97% (n = 191) and the percentage of peripheral precocious puberty was 3% (n=7). Ninety percent of 191 (n=172) cases with CPP were girls and 10% (n=19) were boys. Of those with CPP, 90% (n=171) were idiopathic and 10% (n=20) due to organic causes. No significant endocrine disruption exposure was found in our patients. Basal LH level was ≥ 0.2 mIU/mL in 82.5% of all girls with a diagnosis of CPP, and the mean basal LH level was 1.66 ± 1.70 mIU/mL. The mean LHRH-stimulated peak LH level was 12.97 ± 10.09 mIU/mL in all girls with a diagnosis of CPP, and the stimulated LH level was ≥5 mIU/mL in 61% of our patients. Although there were increases in BMI-percentile and BMI-SDS in the first year, second year and last control in our girl cases who received GnRHa treatment for at least two years, the differences were not significant. In these cases, final control BA/KA and Δ(BA-TA) were significantly lower than before treatment (p <0.05). Growth rate and growth rate-SDS in the second year of treatment were significantly lower compared to the first year (p <005). Final control predicted adult height (PAH) and PAH-SDS were significantly higher than baseline (p <0.001). The final control BMI-SDS of our female cases who were normal according to their BMI was not significant (p >0.05), but there was a significant increase in the final control BMI-SDS of our overweight / obese female cases compared to the baseline (p <0.05). In addition, the difference was not significant in the last control BMI-SDS in our normal and overweight / obese patients who only received leuprolide acetate compared to baseline. Conclusion: Our study is a study showing the long-term effects of GnRHa treatment on anthropometry in our female patients with CPP. In this study, the site and importance of LHRH stimulation test in diagnosis was demonstrated. Consistent with the literature, most of our cases were idiopathic CPP and female gender was dominant in our study. Considering the results of the anthropometric and clinical findings evaluated in our study, it was seen that GnRHa was effective and had very low side effects in the treatment of our patients with CPP. In order to better manage the potential negative effects of GnRHa on weight, we recommend that patients with SEE who receive long-term GnRHa treatment should receive consultancy services for their lifestyle and eating habits during the treatment. Key words: Body mass index, gonadotropin-releasing hormone analogues, height gain, precocious puberty.