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      Higher prevalence of obesity and overweight without an adverse metabolic profile in girls with central precocious puberty compared to girls with early puberty, regardless of GnRH analogue treatment

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          Abstract

          Objectives

          1. To determine BMI, obesity/overweight rates, glucose and lipids at baseline, during GnRHa treatment and shortly after therapy discontinuation in female children with CPP and EP. 2. To compare this response to that seen in a similar group of untreated patients.

          Methods

          A retrospective analysis of 71 children with either CPP (n = 37) or EP (n = 34) was undertaken. Forty three were treated with a GnRHa for at least 2 years, while 28 were followed without treatment.

          Results

          At the time of diagnosis, a higher BMI (z-score of 1.1 ± 0.8 vs. 0.6 ± 0.7, p = 0.004) and a higher prevalence of obesity/overweight (72.9 vs. 35.3%, p = 0.001) was observed in subjects with CPP when compared to those with EP. Children with EP had higher fasting glucose and total cholesterol than those with CPP. BMI z-score, obesity/overweight rates, fasting glucose and lipids did not change significantly in girls with CPP or EP during 3 yrs of follow up, regardless of treatment. Weight z-scores were higher at 3 years in treated than in untreated girls with CPP (p = 0.02), while it was higher in untreated than in GnRHa-treated patients with EP at baseline, 1, 2 and 3 years (p = 0.007, p = 0.002, p = 0.02 and p = 0.04, respectively) and remained so shortly after stopping therapy (p = 0.03).

          Conclusions

          There is a high prevalence of obesity/overweight in girls with CPP and EP at diagnosis. However, this risk is greater in CPP than in EP girls. BMI, Obesity/overweight rates, fasting glucose and lipids remained stable in CPP and EP girls regardless of therapy. Weight z-scores were found to be higher in treated CPP girls and in untreated girls with EP.

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          Most cited references 20

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          Weight status in young girls and the onset of puberty.

          We sought to examine the association between weight status in early childhood and onset of puberty. The study included 354 girls from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. Girls were followed longitudinally with height and weight measurements at 36 and 54 months and grades 1, 4, 5, and 6 and with assessment of pubertal stage by physical examination and maternal report in grades 4 through 6. The main outcome was the presence of early puberty, indexed as follows: (a) breast development at or more than Tanner stage 2 by physical examination at grade 4; (b) breast development at or more than Tanner stage 3 by physical examination at grade 5; (c) maternal report of breast development at or more than Tanner stage 3 at grade 5; and (d) maternal report of menarche having already occurred (yes versus no) at grade 6. Multiple logistic regression models predicting early versus late puberty were constructed by using the covariate BMI z score at 36 months, rate of change of BMI and accelerated BMI between 36 months and grade 1, race, maternal education, and maternal age of menarche. BMI z score at 36 months, rate of change of BMI between 36 months and grade 1, an earlier age of maternal menarche, and nonwhite race were each consistently and positively associated with an earlier onset of puberty across the various measures of puberty. Higher BMI z score in girls as young as 36 months of age and higher rate of change of BMI between 36 months old and grade 1, a period well before the onset of puberty, are associated with earlier puberty, which suggests that increasing rates of obesity in the United States may result in an earlier average age of onset of puberty for US girls.
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            Percent body fat at age 5 predicts earlier pubertal development among girls at age 9.

            This study examines the causal direction of the relationship between weight status and pubertal timing in girls using a longitudinal sample of 183 white girls followed from ages 5 to 9. Girls' weight status (body mass index percentile, percent body fat, waist circumference) was assessed when they were 5, 7, and 9 years old, and their pubertal development was assessed when they were 9 years old (breast development, Estradiol, Pubertal Development Scale). Information from all measures of pubertal development at 9 years was combined to identify girls exhibiting earlier (N = 44) and later (N = 136) pubertal development relative to the sample. Girls' weight status at each age (5, 7, and 9 years old) and change in weight status across the ages of 5 to 9 years were used to predict their pubertal timing at 9 years of age. Girls with higher percent body fat at 5 years, and girls with higher percent body fat, higher BMI percentile, or larger waist circumference at 7 years, were more likely to be classified with earlier pubertal development at 9 years. In addition, girls showing larger increases in percent body fat from 5 to 9 years of age, and larger increases in waist circumference from 7 to 9 years of age, were more likely to exhibit earlier pubertal development at 9 years. Results were still present after controlling for accelerated growth. Girls with higher weight status in early childhood were more likely to exhibit earlier pubertal development relative to peers at 9 years, indicating that weight status preceded pubertal timing in girls.
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              Growth pattern and final height after cessation of gonadotropin-suppressive therapy in girls with central sexual precocity.

              The objective of the study was to determine whether height gain after discontinuation of gonadotropin-suppressive (GnRHa) therapy differs in girls with sexual precocity diagnosed at various ages and assess its influence on final height (FHt) outcome. We compared data on post-GnRHa treatment course and FHt of 115 girls [22 diagnosed before chronological age of 6 yr; 38 between ages 6 and 8 yr; and 55 early fast puberty (EFP) between ages 8 and 9 yr] treated with GnRHa from Tanner stage 2-3 to chronological age 11-12 yr and bone age 12-12.5 yr. Despite comparable bone age at cessation of treatment, similar time to resumption of puberty (0.6 +/- 0.7, 0.5 +/- 0.7, and 0.5 +/- 0.7 yr), and age at menarche (12.6 +/- 0.5, 12.6 +/- 0.6, and 12.7 +/- 0.9 yr), height gain from cessation of therapy to FHt was greater and time to epiphyseal fusion was longer in the younger central precocious puberty (CPP) than in the older CPP (P < 0.05) and EFP (P < 0.001) groups. The percentage of residual growth predicted at discontinuation of treatment was achieved only by the younger CPP (6.6 +/- 1.6% vs. 6.7 +/- 1.6%), whereas in older CPP and EFP, it was significantly lower (6.2 +/- 1.6% vs. 4.6 +/- 2.7% and 6.3 +/- 1.5% vs. 3.6 +/- 1.5%, respectively). FHt of these two groups was compromised, compared with FHt predicted at discontinuation of treatment (P < 0.01 and P < 0.001, respectively). Girls with sexual precocity diagnosed after the age of 6 yr exhibit earlier epiphyseal fusion with diminished posttreatment height gain and compromised FHt. Because recovery of gonadal axis was similar in all girls, differences were probably due to pretreatment intrinsic changes in the growth plate. Prediction of residual growth at discontinuation of treatment is unreliable in these girls.
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                Author and article information

                Contributors
                Journal
                Int J Pediatr Endocrinol
                Int J Pediatr Endocrinol
                International Journal of Pediatric Endocrinology
                BioMed Central
                1687-9848
                1687-9856
                2014
                17 April 2014
                : 2014
                : 1
                : 5
                Affiliations
                [1 ]Department of Pediatrics, Hospital Dr. Patrocinio Peñuela-IVSS, San Cristobal, Táchira 5001, Venezuela
                [2 ]Pediatric Endocrine Unit, Hospital de Clínicas Caracas, Caracas, Venezuela
                Article
                1687-9856-2014-5
                10.1186/1687-9856-2014-5
                4005618
                24742263
                Copyright © 2014 Colmenares et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Research

                Pediatrics

                central precocious puberty, early puberty, gnrha, bmi, overweight and obesity rates, glucose, lipids

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