This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Palmert, M. R. Articles by Boepple, P. A. Search for Related Content PubMed PubMed Citation Articles by Palmert, M. R. Articles by Boepple, P. A.

Is Obesity an Outcome of Gonadotropin-Releasing Hormone Agonist Administration? Analysis of Growth and Body Composition in 110 Patients with Central Precocious Puberty¹

Divisions of Endocrinology (M.R.P., J.F.C.) and Adolescent Medicine (M.J.M.), Department of Medicine, Children’s Hospital, Boston, Massachusetts 02115; the Clinical Investigator Training Program, Beth Israel Deaconess Medical Center-Harvard/Massachusetts Institute of Technology, Division of Health Sciences and Technology, in collaboration with Pfizer, Inc. (M.R.P.), Boston, Massachusetts 02115; the Reproductive Endocrine Unit (W.F.C., P.A.B.) and the Pediatric Endocrine Unit (J.D.C., P.A.B.), Massachusetts General Hospital, Boston, Massachusetts 02114

Address all correspondence and requests for reprints to; Paul A. Boepple, M.D., Reproductive Endocrine Unit, Bartlett Hall Extension 5, Massachusetts General Hospital, Fruit Street, Boston, Massachusetts 02114.

Concern has been raised that children with central precocious puberty (CPP) are prone to the development of obesity. Here we report longitudinal height, weight, and body mass index (BMI) data from 96 girls and 14 boys with CPP before, during, and after GnRH agonist (GnRHa) administration. Skinfold thickness (n = 46) and percent body fat by dual energy x-ray absorptiometry (n = 21) were determined in subsets for more accurate assessment of body composition and to validate the use of the BMI SD score as an index of body fatness in our subjects.

Before the initiation of therapy (PRE), the girls with CPP had a mean BMI SD score for chronological age (CA) of 1.1 ± 0.1 and for bone age (BA) of 0.1 ± 0.1. By the end of the study, 12–24 months after the discontinuation of GnRHa, the mean BMI SD score was 0.9 ± 0.1 for CA and 0.6 ± 0.1 for BA. At the visit when GnRHa was discontinued, 41% and 22% of the girls had a BMI SD score for CA more than the 85th and 95th percentiles, respectively, indicating that obesity was present at a high rate among our subjects; the BMI SD score for CA at the PRE visit was its strongest predictor. Indeed, 86% of the girls with BMI SD score for CA above the 85th percentile when GnRHa was discontinued also had BMI SD score for CA above the 85th percentile at the PRE visit.

The proportion of boys with elevated BMI SD score for CA was also high. Fifty-four percent and 31% of the SD scores were greater than the 85th and 95th percentiles after 36 months of GnRHa therapy; the BMI SD score for CA PRE had been above the 85th percentile in 71% of these overweight subjects.

Obesity occurs at a high rate among children with CPP, but does not appear to be related to long term pituitary-gonadal suppression induced by GnRHa administration. Children with CPP should have a baseline BMI SD score calculated, and those at risk for obesity should be counseled appropriately.

This article has been cited by other articles:

				V. N. Brito, A. C. Latronico, P. Cukier, M. G. Teles, L. F. G. Silveira, I. J. P. Arnhold, and B. B. Mendonca Factors Determining Normal Adult Height in Girls with Gonadotropin-Dependent Precocious Puberty Treated with Depot Gonadotropin-Releasing Hormone Analogs J. Clin. Endocrinol. Metab., July 1, 2008; 93(7): 2662 - 2669. [Abstract] [Full Text] [PDF]

				J.-C. Carel and J. Leger Precocious Puberty N. Engl. J. Med., May 29, 2008; 358(22): 2366 - 2377. [Full Text] [PDF]

				A. M. Pasquino, I. Pucarelli, F. Accardo, V. Demiraj, M. Segni, and R. Di Nardo Long-Term Observation of 87 Girls with Idiopathic Central Precocious Puberty Treated with Gonadotropin-Releasing Hormone Analogs: Impact on Adult Height, Body Mass Index, Bone Mineral Content, and Reproductive Function J. Clin. Endocrinol. Metab., January 1, 2008; 93(1): 190 - 195. [Abstract] [Full Text] [PDF]

				L. Lazar, A. Padoa, and M. Phillip Growth Pattern and Final Height after Cessation of Gonadotropin-Suppressive Therapy in Girls with Central Sexual Precocity J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3483 - 3489. [Abstract] [Full Text] [PDF]

				K. Sorensen, A. M. Andersson, N. E. Skakkebaek, and A. Juul Serum Sex Hormone-Binding Globulin Levels in Healthy Children and Girls with Precocious Puberty before and during Gonadotropin-Releasing Hormone Agonist Treatment J. Clin. Endocrinol. Metab., August 1, 2007; 92(8): 3189 - 3196. [Abstract] [Full Text] [PDF]

				S. A. van Gool, G. A. Kamp, H. Visser-van Balen, D. Mul, J. J. J. Waelkens, M. Jansen, L. Verhoeven-Wind, H. A. Delemarre-van de Waal, S. M. P. F. de Muinck Keizer-Schrama, G. Leusink, et al. Final Height Outcome after Three Years of Growth Hormone and Gonadotropin-Releasing Hormone Agonist Treatment in Short Adolescents with Relatively Early Puberty J. Clin. Endocrinol. Metab., April 1, 2007; 92(4): 1402 - 1408. [Abstract] [Full Text] [PDF]

				C Traggiai, P P. Perucchin, K Zerbini, R Gastaldi, P De Biasio, and R Lorini Outcome after depot gonadotrophin-releasing hormone agonist treatment for central precocious puberty: effects on body mass index and final height Eur. J. Endocrinol., September 1, 2005; 153(3): 463 - 464. [Full Text] [PDF]

				J. D. Veldhuis, J. N. Roemmich, E. J. Richmond, A. D. Rogol, J. C. Lovejoy, M. Sheffield-Moore, N. Mauras, and C. Y. Bowers Endocrine Control of Body Composition in Infancy, Childhood, and Puberty Endocr. Rev., February 1, 2005; 26(1): 114 - 146. [Abstract] [Full Text] [PDF]

				P. Zhou, B. Shah, K. Prasad, and R. David Letrozole Significantly Improves Growth Potential in a Pubertal Boy With Growth Hormone Deficiency Pediatrics, February 1, 2005; 115(2): e245 - e248. [Abstract] [Full Text] [PDF]

				A.-S. Parent, G. Teilmann, A. Juul, N. E. Skakkebaek, J. Toppari, and J.-P. Bourguignon The Timing of Normal Puberty and the Age Limits of Sexual Precocity: Variations around the World, Secular Trends, and Changes after Migration Endocr. Rev., October 1, 2003; 24(5): 668 - 693. [Abstract] [Full Text] [PDF]

				M. M. Lee Is Treatment with a Luteinizing Hormone-Releasing Hormone Agonist Justified in Short Adolescents? N. Engl. J. Med., March 6, 2003; 348(10): 942 - 945. [Full Text] [PDF]

				F. Antoniazzi, G. Zamboni, F. Bertoldo, S. Lauriola, F. Mengarda, A. Pietrobelli, and L. Tato Bone Mass at Final Height in Precocious Puberty after Gonadotropin-Releasing Hormone Agonist with and without Calcium Supplementation J. Clin. Endocrinol. Metab., March 1, 2003; 88(3): 1096 - 1101. [Abstract] [Full Text] [PDF]

				L. Lazar, R. Kauli, A. Pertzelan, and M. Phillip Gonadotropin-Suppressive Therapy in Girls with Early and Fast Puberty Affects the Pace of Puberty but Not Total Pubertal Growth or Final Height J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 2090 - 2094. [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. R. Palmert, D. L. Hayden, M. J. Mansfield, J. F. Crigler Jr., W. F. Crowley Jr., D. W. Chandler, and P. A. Boepple The Longitudinal Study of Adrenal Maturation during Gonadal Suppression: Evidence That Adrenarche Is a Gradual Process J. Clin. Endocrinol. Metab., September 1, 2001; 86(9): 4536 - 4542. [Abstract] [Full Text] [PDF]

				G. A. Kamp, D. Mul, J. J. J. Waelkens, M. Jansen, H. A. Delemarre-van de Waal, L. Verhoeven-Wind, M. Frolich, W. Oostdijk, and J. M. Wit A Randomized Controlled Trial of Three Years Growth Hormone and Gonadotropin-Releasing Hormone Agonist Treatment in Children with Idiopathic Short Stature and Intrauterine Growth Retardation J. Clin. Endocrinol. Metab., July 1, 2001; 86(7): 2969 - 2975. [Abstract] [Full Text] [PDF]

				N. Mauras, K. O. O’Brien, K. O. Klein, and V. Hayes Estrogen Suppression in Males: Metabolic Effects J. Clin. Endocrinol. Metab., July 1, 2000; 85(7): 2370 - 2377. [Abstract] [Full Text]