Endocrine Abstracts

JOINT1450

Objective: The rising incidence of central precocious puberty (CPP) has led to increasing use of Gonadotropin-releasing hormone (GnRH)-analogues. There have been inconsistent reports on the possible risk of increased adiposity with GnRH-analogue use. This study evaluated the association between GnRH-analogue use and adiposity change in females with idiopathic central precocious puberty or early puberty (EP).

Design: A PRISMA-compliant systematic review was conducted using the following databases: PubMed, Embase, Scopus, PsycInfo and Cochrane. Inclusion criteria were primary studies on females diagnosed with idiopathic CPP/EP who received GnRH-analogues, where quantitative measures of adiposity were reported. The JBI Critical Appraisal Tool for Observational Studies was used for quality assessment of individual studies. A meta-analysis was performed, with subgroup analyses based on baseline body mass index (BMI) status and GnRH-analogue type.

Results: Forty-six cohort studies with 3,606 females who received GnRH-analogues for CPP/EP were included. The mean age of the study participants at initiation of GnRH-analogue was 8.07 (1.19) years, while duration of treatment ranged from 6 months to > 4 years. BMI-SDS had increased significantly within 2 years of therapy (0.17, 95% CI 0.12–0.23) and at the end of therapy (0.10, 95% CI 0.02–0.18). There was no significant change in BMI-SDS beyond 2 years of therapy (0.09, 95% CI -0.02–0.20) nor at final height (-0.10, 95% CI -0.24–0.05). Between the start to end of therapy, females with normal BMI at baseline experienced significant increase in BMI-SDS (0.32, 95% CI 0.22–0.42) compared to those with overweight or obesity (BMI-SDS -0.03, 95% CI -0.09–0.02). Leuprorelin use was associated with a mild but significant increase in BMI-SDS between the start and end of therapy (0.12, 95% CI 0.03–0.21), but this was not observed with triptorelin use.

Conclusions: GnRH-analogue use in females is associated with a transient increase in BMI-SDS during, but not beyond therapy. Females with normal BMI at baseline are at higher risk of significant BMI-SDS increase during therapy. These findings are clinically important to guide counselling and monitoring of individuals with CPP/EP who receive GnRH-analogue therapy.