Erken telarş, erken pubarş: Metabolik sendrom ve over kökenli hiperandrojenizm ile ne kadar ilişkili?
Küçük Resim Yok
Tarih
2010
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Erken pubarşla ilgili ileri dönem riskleri tanımlayan çok sayıda çalışmaolmakla beraber, erken telarşın olası ileri dönem riskleri üzerinde yapılan çalışmayarastlanmamıştır.Amaç : Prematür telarşın da prematür pubarş gibi, erişkin dönemdemetabolik belirteçlerde gelişebilecek bozuklukların erken göstergesi olup olmadığınıdeğerlendirmekOlgular : Çalışmaya, ergenlik bulgularının erken gelişme öyküsü olan, 15yaş üzeri toplam 27 kız olgu alındı. Olgular, erken ergenlik bulguları ile 3,5-9,2yaşları arasında Ege Üniversitesi Tıp Fakültesi Pediatrik Endokrinoloji Bilim Dalıpolikliniğine başvurmuş olgulardı. Metabolik parametreler yönünden yakınmalar,fizik bakı, laboratuvar verileri ve US ile erişkin dönem değerlendirmeleri yapıldı.Bulgular : Olguların 15'i (%55,6) erken pubarş (EP) ve 12'si (%44,4) erkentelarş (ET) grubunda yer almaktaydı. Ortalama yaşları EP grubunda 16,71±0,94 ; ETgrubunda 17,65±2,69 yıl idi. Erken pubarş grubundaki olguların 2'si (%13,3) veerken telarş grubundaki olguların 5'i (%41,7) izlemde santral erken puberte tablosugöstermişti. Bunların dışındaki olguların izole erken pubarş (İEP) ve izole erkentelarş (İET) olarak ayrıca değerlendirmeleri de yapıldı. EP ve ET, İEP ve İETgruplarında, doğum ağırlığı SDS değerlerinin puberte bulgularının başlangıç yaşlarıüzerine etkisi saptanmadı (p>0,05).EP gelişen olguların ağırlık SDS ve VKI SDSdeğerleri arttıkça, daha erken yaşta menarşla karşılaşıldığı; ET olguların da, ağırlıkSDS değerleri arttıkça aksiler/pubik kıllanma yaşının erkene kaydığı görülmüştür(p<0,05). ET tablosu ile ergenliğe giren olguların beklenen hedef boya ulaştıklarıgörülmektedir (r=0,78 ; p=0,003 ). EP öyküsü olan olguların ise, ergenlik bulgularıbaşladığı dönemde hesaplanan TEB (Tahmini Erişkin Boy) değerlerini yakaladığıgörülmektedir (r=0,53 ; p=0,03). ET ve İET olgularda VKI ve vücut yağ oranıarttıkça, SHBG düzeyleri düştükçe, IGF BP1 düzeylerinin de düşük saptandığı; İEPgrubunda da DHEA-S ve ortalama over volüm değerleri arttıkça IGF BP1düzeylerinin düştüğü görülmüştür (p<0,05).Sonuç : Prematür telarş da erişkin dönemde gelişebilecek metabolikbozuklukların habercisi olabilir. Kilo fazlalığı, bu riski artırmaktadır.Prematür telarşgelişen olgulara, ilk değerlendirmedeki verilerle, ileride hiçbir sorunu olmayacağınadair güvence verilemez, izlem gerektirirAnahtar Kelimeler: Kız çocuk, erken puberte, metabolik sendrom
Despite the extensive body of research studies defining the later risksassociated with premature pubarche, no study was found to address the possible laterrisks of premature thelarche.Objective: The objective of this study is to examine whether prematurethelarche is an early indicator of disorders that may develop in metabolic markers inadulthood as is the case in premature pubarche.Cases: The study included 27 girls above the age of 15 with a history of earlydevelopment of puberty symptoms. All cases had applied to the Department ofPaediatric Endocrinology of Ege University Faculty of Medicine between the ages of3,5 and 9,2. Adulthood assessments were conducted with complaints related tometabolic parameters, physical examination, laboratory data and US.Findings: Among the cases, 15 (55,6%) were in the premature pubarche (PP)group and 12 (44,4%) in the premature thelarche (PT) group. The mean age was16,71±0,94 in the PP group and 17,65±2,69 in the PT group. 2 (13,3%) of the casesin the premature pubarche group and 5 (41,7%) of the cases in the prematurethelarche group presented a story of central precocious puberty in follow-up. Theremaining cases were made subject to additional assessments and identified asisolated premature pubarche (IPP) and isolated premature thelarche (IPT) groups. InPP, PT, IPP and IPT groups, birth weight SDS values were not found to have anyeffect on the age of onset of puberty symptoms (p>0,05). It was determined that inPP cases, the weight SDS and BMI SDS values increased in inverse proportion withthe age of onset of menarche and in PT cases, weight SDS values increased ininverse proportion with the age of onset of axillary/pubic hair development (p<0,05).Cases that reached puberty with a story of PT were observed to have reached theexpected target height (r=0,78; p=0,003). Cases with a story of PP, on the otherhand, were seen to have reached the PAH (Predictive Adult Height) values calculatedat the onset of puberty symptoms (r=0,53; p=0,03). In PT and IPT cases, IGFBP1levels were observed to decrease as BMI and body fat increased and SHBG levelsdecreased, whereas in the IPP group, IGFBP1 levels were determined to decrease asDHEA-S and mean ovary volume values increased (p<0,05).Results: Premature thelarche may also be an indicator of metabolic disordersthat may develop in adulthood. Being overweight increases this risk. Cases with astory of premature thelarche cannot be given a guarantee that no problems willemerge in the future on the basis of the data obtained in initial assessments. Such aconclusion could only be reached upon a follow-up.Keywords: Girl, premature puberty, metabolic syndrome.
Despite the extensive body of research studies defining the later risksassociated with premature pubarche, no study was found to address the possible laterrisks of premature thelarche.Objective: The objective of this study is to examine whether prematurethelarche is an early indicator of disorders that may develop in metabolic markers inadulthood as is the case in premature pubarche.Cases: The study included 27 girls above the age of 15 with a history of earlydevelopment of puberty symptoms. All cases had applied to the Department ofPaediatric Endocrinology of Ege University Faculty of Medicine between the ages of3,5 and 9,2. Adulthood assessments were conducted with complaints related tometabolic parameters, physical examination, laboratory data and US.Findings: Among the cases, 15 (55,6%) were in the premature pubarche (PP)group and 12 (44,4%) in the premature thelarche (PT) group. The mean age was16,71±0,94 in the PP group and 17,65±2,69 in the PT group. 2 (13,3%) of the casesin the premature pubarche group and 5 (41,7%) of the cases in the prematurethelarche group presented a story of central precocious puberty in follow-up. Theremaining cases were made subject to additional assessments and identified asisolated premature pubarche (IPP) and isolated premature thelarche (IPT) groups. InPP, PT, IPP and IPT groups, birth weight SDS values were not found to have anyeffect on the age of onset of puberty symptoms (p>0,05). It was determined that inPP cases, the weight SDS and BMI SDS values increased in inverse proportion withthe age of onset of menarche and in PT cases, weight SDS values increased ininverse proportion with the age of onset of axillary/pubic hair development (p<0,05).Cases that reached puberty with a story of PT were observed to have reached theexpected target height (r=0,78; p=0,003). Cases with a story of PP, on the otherhand, were seen to have reached the PAH (Predictive Adult Height) values calculatedat the onset of puberty symptoms (r=0,53; p=0,03). In PT and IPT cases, IGFBP1levels were observed to decrease as BMI and body fat increased and SHBG levelsdecreased, whereas in the IPP group, IGFBP1 levels were determined to decrease asDHEA-S and mean ovary volume values increased (p<0,05).Results: Premature thelarche may also be an indicator of metabolic disordersthat may develop in adulthood. Being overweight increases this risk. Cases with astory of premature thelarche cannot be given a guarantee that no problems willemerge in the future on the basis of the data obtained in initial assessments. Such aconclusion could only be reached upon a follow-up.Keywords: Girl, premature puberty, metabolic syndrome.
Açıklama
Anahtar Kelimeler
Endokrinoloji ve Metabolizma Hastalıkları, Endocrinology and Metabolic Diseases, Çocuk Sağlığı ve Hastalıkları, Child Health and Diseases, Ergenlik, Puberty, Hiperandrojenizm, Hyperandrogenism, Kız çocukları, Young girls, Metabolik sendrom, Metabolic syndrome, Metabolizma, Metabolism, Over, Ovary
