Journal of Clinical Endocrinology & Metabolism, Vol 72, 301-307, Copyright © 1991 by Endocrine Society

ARTICLES

Low growth hormone levels are related to increased body mass index and do not reflect impaired growth in luteinizing hormone-releasing hormone agonist-treated children with precocious puberty

GA Kamp, PK Manasco, KM Barnes, J Jones, SR Rose, SC Hill and GB Cutler Jr
Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892.

To test the hypothesis that GH deficiency might explain the low growth velocity of some LHRH agonist (LHRHa)-treated children with central precocious puberty, we measured stimulated (n = 81) and spontaneous (n = 32) GH levels during or after LHRHa treatment. GH stimulation tests in the children who were receiving LHRHa treatment were performed after 2 days of ethinyl estradiol administration. Thirty-one of 81 children (38%) who underwent GH stimulation tests had subnormal responses (less than or equal to 7 micrograms/L) to all tests administered (at least 2 stimuli), including 22 of 67 (33%) who had precocious puberty that was idiopathic or associated with hypothalamic hamartoma. Eleven of 32 children (34%) who underwent measurement of the mean nighttime spontaneous GH level had levels below the normal range for prepubertal children (less than 1.2 microgram/L). Despite the high incidence of subnormal GH levels, there appeared to be no relationship between the GH levels of these children and their growth characteristics. The height, growth velocity, bone maturation rate, predicted height, and insulin-like growth factor-I levels were not different between the children with low GH levels and the children with normal GH levels. Conversely, the GH levels were not different between the children with subnormal growth rates and the children with normal growth rates. Thus, variation in the growth rates of these LHRHa-treated children with central precocious puberty could not be explained by variation in the stimulated or spontaneous secretion of GH. In attempting to understand the high incidence of low GH levels in children with precocious puberty, we examined the relationship between GH level and body mass index (BMI). Both the stimulated (r = -0.33; P less than 0.002) and the spontaneous (r = -0.61; P less than 0.0002) GH levels were inversely related to BMI. Moreover, the children with precocious puberty as a group had significantly elevated BMI [1.2 +/- 0.1 (+/- SE) SD units] compared to normal children of the same age (P less than 0.0001). Thus, increased body mass may explain the high incidence of subnormal GH levels in these patients, and normative GH levels adjusted for body mass are needed before it can be concluded that the apparently subnormal GH levels in LHRHa-treated children with precocious puberty are in fact low.

This article has been cited by other articles:

				M. Weise, A. Flor, K. M. Barnes, G. B. Cutler Jr., and J. Baron Determinants of Growth during Gonadotropin-Releasing Hormone Analog Therapy for Precocious Puberty J. Clin. Endocrinol. Metab., January 1, 2004; 89(1): 103 - 107. [Abstract] [Full Text] [PDF]

				I. M. van der Sluis, A. M. Boot, E. P. Krenning, S. L. S. Drop, and S. M. P. F. de Muinck Keizer-Schrama Longitudinal Follow-Up of Bone Density and Body Composition in Children with Precocious or Early Puberty before, during and after Cessation of GnRH Agonist Therapy J. Clin. Endocrinol. Metab., February 1, 2002; 87(2): 506 - 512. [Abstract] [Full Text] [PDF]

				M. Weise, S. De-Levi, K. M. Barnes, R. I. Gafni, V. Abad, and J. Baron Effects of estrogen on growth plate senescence and epiphyseal fusion PNAS, May 24, 2001; (2001) 121180498. [Abstract] [Full Text] [PDF]

				Is Obesity an Outcome of Gonadotropin-Releasing Hormone Agonist Administration? Analysis of Growth and Body Composition in 110 Patients with Central Precocious Puberty J. Clin. Endocrinol. Metab., December 1, 1999; 84(12): 4480 - 4488. [Abstract] [Full Text]

				E. C. Walvoord and O. H. Pescovitz Combined Use of Growth Hormone and Gonadotropin-releasing Hormone Analogues in Precocious Puberty: Theoretic and Practical Considerations Pediatrics, October 1, 1999; 104(4): 1010 - 1014. [Abstract] [Full Text]

				A. M. Pasquino, I. Pucarelli, M. Segni, M. Matrunola, and F. Cerrone Adult Height in Girls with Central Precocious Puberty Treated with Gonadotropin-Releasing Hormone Analogues and Growth Hormone J. Clin. Endocrinol. Metab., February 1, 1999; 84(2): 449 - 452. [Abstract] [Full Text]

				A. M. Boot, S. M. P. F. d. M. Keizer-Schrama, H. A. P. Pols, E. P. Krenning, and S. L. S. Drop Bone Mineral Density and Body Composition before and during Treatment with Gonadotropin-Releasing Hormone Agonist in Children with Central Precocious and Early Puberty J. Clin. Endocrinol. Metab., February 1, 1998; 83(2): 370 - 373. [Abstract] [Full Text]

				T. Löppönen, A.-L. Saukkonen, W. Serlo, P. Tapanainen, A. Ruokonen, and M. Knip Reduced levels of growth hormone, insulin-like growth factor-I and binding protein-3 in patients with shunted hydrocephalus Arch. Dis. Child., July 1, 1997; 77(1): 32 - 37. [Abstract] [Full Text]

				M. Weise, S. De-Levi, K. M. Barnes, R. I. Gafni, V. Abad, and J. Baron Effects of estrogen on growth plate senescence and epiphyseal fusion PNAS, June 5, 2001; 98(12): 6871 - 6876. [Abstract] [Full Text] [PDF]