조기 사춘기 여아에서 성선자극호르몬 분비호르몬 유도체가 성장과 성호르몬에 미치는 효과

Abstract

Purpose: Gonadotropin releasing hormone agonist (GnRHa) treatment is widely used in precocious puberty to delay rapid pubertal growth and increase final height. But, girls who enter puberty 8 to 9 years also have same course with precocious puberty in many cases. Therefore GnRHa treatment is used in girls with early puberty, but the effects are controversial. We analyzed growth velocity and sex hormone concentrations in early puberty during and after GnRHa treatment.

Methods: The subjects were included 77 girls who had sexual development during 8 to 9 years, and they were treated with GnRHa over 6 months. We analyzed chronologic age (CA), bone age (BA), predicted adult height (PAH), breast development and serum LH, FSH, E2 levels during and after treatment. Additionally we analyzed height and growth velocity of 17 subjects who were treated with GnRHa plus GH.

Results: CA was 8.7±1.1 yrs and BA was 10.3±1.7 yrs at diagnosis. Growth velocity was decreased from 7.4±2.0 cm/yr to 4.9±1.1 cm/yr during treatment, but they were increased to 7.9±1.7 cm/yr in 6 months off treatment. PAH SDS was increased from -1.9±1.6 to -1.5±1.5 during treatment. Serum E2 levels were decreased from 16.1±8.7 ng/dL to 9.4±2.4 ng/dL in 3 months after treatment and maintained in low level during treatment. But they began to increase at 3 months off treatment (P= 0.059). Breast development was decreased in 3 months after treatment, however it began to increase in 3 months off treatment. Growth velocities were increased from 4.7 cm/yr to 6.6 cm/yr in 3months after combination treatment of GnRHa plus GH. PAH SDS was significantly increased in GnRHa plus GH treatment compared to GnRHa treatment only.

Conclusion: GnRHa treatment suppressed rapid progress of early puberty effectively from start of treatment. It could be useful to relieve psychosocial problems in early puberty. PAH SDS was increased during GnRHa treatment, but it was increased more in GnRHa plus GH treatment. GH combination treatment should be considered if growth velocity was decreased seriously.