Evaluation of the efficiency of treatment in girls with central precocious puberty/rapidly progressive puberty via ultrasonography
Öz
Introduction: Central precocious puberty (CPP) is defined as the development of secondary sexual characteristics in girls before the age of 8 years due to the activation of the hypothalamus-pituitary-gonadal (HPG) axis, and long-acting GnRH analogues (GnRHa) are used in its standard treatment. The gold standard method for evaluating the efficiency of treatment is to demonstrate the suppression of the LH response with the GnRH stimulation test. Pelvic ultrasonography (US) is an easily accessible, safe, free of ionizing radiation and non-invasive imaging method, which is used for the evaluation of internal genital organs, monitoring of sexual development, and excluding ovarian mass. This study aimed to evaluate the effect of GnRHa treatment on internal genital organs and to determine the role of pelvic ultrasonography in treatment follow-up.
Material and Method: Between January 2017 and May 2021, 50 girls who were started on GnRHa treatment due to the diagnosis of CPP or rapidly progressing puberty were followed up, and who underwent pelvic US imaging at the beginning of treatment and in the 1st year of treatment were included in the study. The clinical and sonographic findings were compared before and after the treatment.
Results: Of the 50 patients in the study, 52% (n=26) were being followed up with CPP, and 48% (n=24) with rapidly progressive puberty. In the first year of GnRHa treatment, while the suppression of the HPG axis was detected in 82% (n=41) of the cases with the GnRHa test, there was no suppression in 18% (n=9). A decrease in ovarian volume was observed in 73.2% (n=30) of 41 patients with suppression of the HPG axis, a decrease in uterine volume in 65.9% (n=27), and a decrease in uterine anterior-posterior size in 61% (n=25). While endometrial thickness could be measured in 64% (n=32) of the cases before treatment, measurable endometrial thickness was detected in only 6% (n=3) of the cases in the 1st year of treatment.
Conclusion: We detected in this study that GnRHa treatment in girls with a diagnosis of CPP/rapid puberty caused a significant regression in ovarian and uterus dimensions and endometrial echo selectability. Our results, in line with the literature, support that pelvic ultrasonography is an appropriate modality for monitoring the suppression of the HPG axis during CPP treatment and may reduce the need for repeated GnRH stimulation tests.
Anahtar Kelimeler
Central precocious puberty ultrasonography GnRHa therapy uterine diamater ovarian volume
Destekleyen Kurum
no
Proje Numarası
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Teşekkür
-
Kaynakça
- Park J, Kim JH. Change in body mass index and insulin resistance after 1-year treatment with gonadotropin-releasing hormone agonists in girls with central precocious puberty. Ann Pediatr Endocrinol Metab 2017; 22: 27-35.
- Partsch CJ, Heger S, Sippell WG. Management and outcome of central precocious puberty. Clin Endocrinol 2002; 56: 129-48.
- Aycan, Z. Delayed puberty. Turkish Archives of Pediatrics 2011; 46: 88-91.
- Stranzinger E, Strouse PJ. Ultrasound of the pediatric female pelvis. Semin Ultrasound CT MR 2008; 29: 98-113.
- Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003; 24: 668-93.
- Berberoğlu M. Puberty precocious. Turkish J Pediatr Dis 2010; 4: 61-4
- Brito VN, Latronico AC, Arnhold IJ, Mendonça BB. Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arq Bras Endocrinol Metabol 2008; 52: 18-31.
- Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009; 123: e752-62.
- Bereket A. A critical appraisal of the effect of gonadotropin-releasing hormon analog treatment on adult height of girls with central precocious puberty. J Clin Res Pediatr Endocrinol 2017; 9: 33-48.
- Brito VN, Latronico AC, Arnhold IJ, Mendonca BB. A single luteinizing hormone determination 2 hours after depot leuprolide is useful for therapy monitoring of gonadotropin-dependent precocious puberty in girls. J Clin Endocrinol Metab 2004; 89: 4338-42.
- Calcaterra V, Sampaolo P, Klersy C, et al. Utility of breast ultrasonography in the diagnostic work-up of precocious puberty and proposal of a prognostic index for identifying girls with rapidly progressive central precocious puberty. Ultrasound Obstet Gynecol 2009; 33: 85-91.
- de Vries L, Phillip M. Role of pelvic ultrasound in girls with precocious puberty. Horm Res Paediatr 2011; 75: 148-52.
- Hall DA, Crowley WF, Wierman ME, Simeone JF, McCarthy KA. Sonographic monitoring of LHRH analogue therapy in idiopathic precocious puberty in young girls. J Clin Ultrasound 1986; 14: 331-8.
- Ambrosino MM, Hernanz-Schulman M, Genieser NB, Sklar CA, Fefferman NR, David R. Monitoring of girls undergoing medical therapy for isosexual precocious puberty. J Ultrasound Med 1994; 13: 501-8.
- Jensen AM, Brocks V, Holm K, Laursen EM, Müller J. Central precocious puberty in girls: internal genitalia before, during, and after treatment with long-acting gonadotropin-releasing hormone analogues. J Pediatr 1998; 132: 105-8.
- Yu HK, Liu X, Chen JK, Wang S, Quan XY. Pelvic ultrasound in diagnosing and evaluating the efficacy of gonadotropin-releasing hormone agonist therapy in girls with idiopathic central precocious puberty. Front Pharmacol 2019; 10: 104.
- Lemaire P, Pierre D, Bertrand JB, Brauner R. A mathematical model for predicting the adult height of girls with advanced puberty after spontaneous growth. BMC Pediatr 2014; 14: 172.
- Onat PŞ, Erdeve ŞS, Çetinkaya S, Aycan Z. Effect of gonadotropin-releasing hormone analog treatment on final height in girls aged 6-10 years with central precocious and early puberty. Turk Pediatri Ars 2020; 55: 361-9
- Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in girls. Arch Dis Child 1969: 44; 291-303.
- Greulich WW, Pyle SI ( editors). Radiographic atlas of the skeletal development of the hand and wrist. 2nd ed., Stanford, CA: Stanford University Press, 1959.
- Bhatia S, Neely EK, Wilson DM. Serum luteinizing hormone rises within minutes after depot leuprolide injection: implications for monitoring therapy. Pediatrics 2002; 109: E30. X
- Lawson ML, Cohen N. A single sample subcutaneous luteinizing hormone (LH)-releasing hormone (LHRH) stimulation test for monitoring LH suppression in children with central precocious puberty receiving LHRH agonists. J Clin Endocrinol Metab 1999; 84: 4536-40.
- Kendirci HN, Ağladıoğlu SY, Baş VN, Önder A, Çetinkaya S, Aycan Z. Evaluating the efficacy of treatment with a GnRH analogue in patients with central precocious puberty. Int J Endocrinol 2015; 2015: 247386.
- Ben-Haroush A, Goldberg-Stern H, Phillip M, de Vries L. GnRH agonist treatment in girls with precocious puberty does not compromise post-pubertal uterine size. Hum Reprod 2007; 22: 895-900.
- Ersen A, Onal H, Yıldırım D, Adal E. Ovarian and uterine ultrasonography and relation to puberty in healthy girls between 6 and 16 years in the Turkish population: a cross-sectional study. J Pediatr Endocrinol Metab 2012; 25: 447-51.
- Wen X, Wen D, Zhang H, Zhang H, Yang Y. Observational study pelvic ultrasound a useful tool in the diagnosis and differentiation of precocious puberty in Chinese girls. Medicine (Baltimore) 2018; 97: e0092.
Öz
Proje Numarası
-
Kaynakça
- Park J, Kim JH. Change in body mass index and insulin resistance after 1-year treatment with gonadotropin-releasing hormone agonists in girls with central precocious puberty. Ann Pediatr Endocrinol Metab 2017; 22: 27-35.
- Partsch CJ, Heger S, Sippell WG. Management and outcome of central precocious puberty. Clin Endocrinol 2002; 56: 129-48.
- Aycan, Z. Delayed puberty. Turkish Archives of Pediatrics 2011; 46: 88-91.
- Stranzinger E, Strouse PJ. Ultrasound of the pediatric female pelvis. Semin Ultrasound CT MR 2008; 29: 98-113.
- Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003; 24: 668-93.
- Berberoğlu M. Puberty precocious. Turkish J Pediatr Dis 2010; 4: 61-4
- Brito VN, Latronico AC, Arnhold IJ, Mendonça BB. Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arq Bras Endocrinol Metabol 2008; 52: 18-31.
- Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009; 123: e752-62.
- Bereket A. A critical appraisal of the effect of gonadotropin-releasing hormon analog treatment on adult height of girls with central precocious puberty. J Clin Res Pediatr Endocrinol 2017; 9: 33-48.
- Brito VN, Latronico AC, Arnhold IJ, Mendonca BB. A single luteinizing hormone determination 2 hours after depot leuprolide is useful for therapy monitoring of gonadotropin-dependent precocious puberty in girls. J Clin Endocrinol Metab 2004; 89: 4338-42.
- Calcaterra V, Sampaolo P, Klersy C, et al. Utility of breast ultrasonography in the diagnostic work-up of precocious puberty and proposal of a prognostic index for identifying girls with rapidly progressive central precocious puberty. Ultrasound Obstet Gynecol 2009; 33: 85-91.
- de Vries L, Phillip M. Role of pelvic ultrasound in girls with precocious puberty. Horm Res Paediatr 2011; 75: 148-52.
- Hall DA, Crowley WF, Wierman ME, Simeone JF, McCarthy KA. Sonographic monitoring of LHRH analogue therapy in idiopathic precocious puberty in young girls. J Clin Ultrasound 1986; 14: 331-8.
- Ambrosino MM, Hernanz-Schulman M, Genieser NB, Sklar CA, Fefferman NR, David R. Monitoring of girls undergoing medical therapy for isosexual precocious puberty. J Ultrasound Med 1994; 13: 501-8.
- Jensen AM, Brocks V, Holm K, Laursen EM, Müller J. Central precocious puberty in girls: internal genitalia before, during, and after treatment with long-acting gonadotropin-releasing hormone analogues. J Pediatr 1998; 132: 105-8.
- Yu HK, Liu X, Chen JK, Wang S, Quan XY. Pelvic ultrasound in diagnosing and evaluating the efficacy of gonadotropin-releasing hormone agonist therapy in girls with idiopathic central precocious puberty. Front Pharmacol 2019; 10: 104.
- Lemaire P, Pierre D, Bertrand JB, Brauner R. A mathematical model for predicting the adult height of girls with advanced puberty after spontaneous growth. BMC Pediatr 2014; 14: 172.
- Onat PŞ, Erdeve ŞS, Çetinkaya S, Aycan Z. Effect of gonadotropin-releasing hormone analog treatment on final height in girls aged 6-10 years with central precocious and early puberty. Turk Pediatri Ars 2020; 55: 361-9
- Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in girls. Arch Dis Child 1969: 44; 291-303.
- Greulich WW, Pyle SI ( editors). Radiographic atlas of the skeletal development of the hand and wrist. 2nd ed., Stanford, CA: Stanford University Press, 1959.
- Bhatia S, Neely EK, Wilson DM. Serum luteinizing hormone rises within minutes after depot leuprolide injection: implications for monitoring therapy. Pediatrics 2002; 109: E30. X
- Lawson ML, Cohen N. A single sample subcutaneous luteinizing hormone (LH)-releasing hormone (LHRH) stimulation test for monitoring LH suppression in children with central precocious puberty receiving LHRH agonists. J Clin Endocrinol Metab 1999; 84: 4536-40.
- Kendirci HN, Ağladıoğlu SY, Baş VN, Önder A, Çetinkaya S, Aycan Z. Evaluating the efficacy of treatment with a GnRH analogue in patients with central precocious puberty. Int J Endocrinol 2015; 2015: 247386.
- Ben-Haroush A, Goldberg-Stern H, Phillip M, de Vries L. GnRH agonist treatment in girls with precocious puberty does not compromise post-pubertal uterine size. Hum Reprod 2007; 22: 895-900.
- Ersen A, Onal H, Yıldırım D, Adal E. Ovarian and uterine ultrasonography and relation to puberty in healthy girls between 6 and 16 years in the Turkish population: a cross-sectional study. J Pediatr Endocrinol Metab 2012; 25: 447-51.
- Wen X, Wen D, Zhang H, Zhang H, Yang Y. Observational study pelvic ultrasound a useful tool in the diagnosis and differentiation of precocious puberty in Chinese girls. Medicine (Baltimore) 2018; 97: e0092.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Orijinal Makale |
| Yazarlar | |
| Proje Numarası | - |
| Yayımlanma Tarihi | 15 Mart 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 5 Sayı: 2 |
Üniversitelerarası Kurul (ÜAK) Eşdeğerliği: Ulakbim TR Dizin'de olan dergilerde yayımlanan makale [10 PUAN] ve 1a, b, c hariç uluslararası indekslerde (1d) olan dergilerde yayımlanan makale [5 PUAN]
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