Reduction of baseline body mass index under gonadotropin-suppressive therapy in girls with idiopathic precocious puberty

Abstract

Objective: To investigate longitudinally body mass index (BMI) evolution and obesity prevalence in a large and very homogeneous study population consisting only of girls with non-organic central precocious puberty (CPP) who were treated with gonadotropin-releasing hormone agonists (GnRHa) for at least two years. Patients and design: The 101 girls with idiopathic CPP who were selected for this study fulfilled the following inclusion criteria: (a) suppression of gonadotropin and gonadal sex steroid secretion during the overall GnRHa treatment period; (b) adequate compliance with the therapy regimen. All the girls were treated for 44^14 months and were followed-up for 15.7^7.8 months after therapy withdrawal. Results: At the start of therapy, 23.8% of the girls had a BMI exceeding 2 standard deviation scores (SDS) and were therefore classified as obese; both average BMI-SDS and obesity prevalence significantly decreased during the treatment period (x 2 ¼ 16.6, P , 0.0005) and only 4% of the patients, all with pre-existing obesity, were still obese at the end of therapy; during the therapy period, BMI-SDS increased in none of the patients. Both average BMI-SDS and obesity prevalence (from 4 to 0%; x 2 ¼ 4.0, P , 0.05) further decreased during the period that followed therapy withdrawal. Conclusions: (a) girls with idiopathic CPP are frequently obese at the onset of GnRHa therapy (23.8%), probably due to the hormonal changes which accompany the start of puberty; (b) their obesity is neither long-lasting nor related to GnRHa administration; (c) on the contrary, GnRHa therapy may have a favourable effect on BMI decrease, provided that treatment is performed for at least two years and is accompanied by a complete suppression of gonadotropin secretion; (d) this unexpected effect, which has never been reported hitherto, might represent a further indication for GnRHa administration in idiopathic CPP.European Journal of Endocrinology 150 533-537

Standard Gonadotropin-Suppressive Therapy in Japanese Girls with Idiopathic Central Precocious or Early Puberty Does Not Adversely Affect Body Composition

“…Chiumello et al suggested that girls with CPP undergo a shortened period of prepubertal lean mass development and so possess an insufficient lean body mass, leading to obesity. (Chiumello et al, 2000) Recently, Arrigo et al hypothesized that the pre-treatment increase in BMI is caused pubertal hormonal changes and secondary changes in body fat rather than CPP itself, as in their series they found that the suppression of pituitary-gonadal axis function was accompanied by a significant decrease in excess weight (Arrigo et al, 2004). However, our results showed that the suppression of the pituitary-gonadal axis did not bring about a significant change in excess weight, as described below.…”

“…On the other hand, Arrigo et al reported 101 girls with CPP who received decapeptyl depot for over 2 years. (Arrigo et al, 2004) As described above, a quarter of the girls were classified as obese at the start of therapy, and only 4% of them were still obese at the end of therapy. BMI SDS did not increase in any of the patients during the therapy period.…”

“…(Arrigo et al, 2004, Boot et al, 1998, Feuillan et al, 1999, Palmert et al, 1999, Chiumello et al, 2000, van der Sluis et al, 2002, Paterson et al, 2004 reported that the mean BMI of 18 girls with precocious puberty due to hypothalamic hamartoma (HH) and 32 with ICPP was higher than normal before GnRHa treatment (Feuillan et al, 1999), and Arrigo et al reported that 23.6% of the 101 girls with ICPP that they studied were obese before the start of therapy. (Arrigo et al, 2004) Our results confirm that obesity is a common problem in children with CPP in Japan. Indeed, in this study, a quarter of our patients were found to be obese according to both BMI and POW before the start of therapy.…”

GH-IGF-IGFBP Axis and Metabolic Profile in Short Children Born Small for Gestational Age

“…Much less attention has been paid to changes in body composition. Some studies report an increase in fat mass or BMI during GnRH analogue treatment, with a return to values comparable to those at baseline after discontinuation (Pasquino et al, 2008;van der Sluis et al, 2002), whereas others report no changes (Palmert et al, 1999) or even a decreased BMI during GnRH analogue treatment (Arrigo et al, 2004). Lean body mass SDS decreases during GnRH analogue treatment (van der Sluis et al, 2002).…”

Randomized GH trial with two different dosages in combination with a GnRH analogue in short small for gestational age children: effects on metabolic profile and serum GH, IGF1, and IGFBP3 levels

“…Studies have focused on body composition, and were performed in children with CPP only. Some studies reported an increase in fat mass or body mass index (BMI) SDS during GnRHa treatment with a return to baseline values after discontinuation (1,2), whereas others reported no changes (3) or even a decreased BMI SDS during GnRHa treatment (4).…”