Evaluation of the Relationship Between Luteinizing Hormone Levels and Body Mass Index in Girls With Idiopathic Central Precocius Puberty

Objective: Excess  adiposity  has  effects on various aspects of pubertal development as  the timing  of pubertal initiation and  hormonal parameters during  puberty. We aimed to determine the effect of BMI on peak LH (luteinizing  hormone) levels obtained by standard GnRH (Gonadotropin  Releasing  Hormone) stimulation  test in girls with central precicous puberty. Materials and Methods: A total of 59  female patients who were diagnosed as idiopathic  central precicous pubertywere included in the study. Anthropometric measurements at the time  of  GnRH stimulation test and basal/stimulated gonadotropin levels were evaluated. The relationship between BMI and gonadotropins  was investigated. Results: The  mean age  of the  participants  was 7.11±1.01 (3.20-7.94) years. 21 cases(35 %) were overweight/obese. 67.8% (n = 40) of the cases were presented with breast development and 64.4% (n = 38) were in stage 2, 35.6% (n = 21) were in stage 3 puberty. There was no  significant correlation between BMI SDS and basal/peak LH levels (p=0.531, p= 0.598 for stage  2  and  p=0.126, p=0.827  for stage  3  puberty respectively), peak LH / FSH (follicle-stimulating hormone)ratio (p=0.408 for  stage  2  and  p=0.797  for stage  3  puberty) in patients according  to  both puberty stages. There was not  also any correlation  between BMI /BMI SDS  and peak LH in total study  group.Basal  LH, FSH, E2  and  peak LH levels  did not  vary  among normal weight, overweight  and  obese  cases. Conclusion: Body mass index had no effect on basal and stimulated gonadotropin levels in girls with central precicous puberty in  different stages of puberty.

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  • REFERENCES1-Herman-Giddens ME, Kaplowitz PB,Wasserman R. Navigating the recent articles on girls’ puberty in Pediatrics: what do we know and where do we go from here? Pediatrics 2014; 113(4):911-917.2-Rosenfield, RL, Lipton RB, Drum ML. Thelarche, pubarche, and menarche attainment in children with normal and elevated body mass index. Pediatrics 2009;123(1): 84-88.3-Wang, Y, Lobstein T. Worldwide trends in childhood overweight and obesity. Int JPediatr Obes. 2006;1(1):11-25.4-Bereket A, Atay Z. Current status of childhood obesity and its associated morbidities in Turkey. J Clin Res Pediatr Endocrinol. 2012;4(1):1-7.5-Cali AM, Caprio S. Obesity in children and adolescents. J Clin Endocrinol Metab. 2008; 93: S31-36.6-Kaplowitz PB, Slora EJ, Wasserman RC, Pedlow SE, Herman-Giddens ME. Earlier onset of puberty in girls: relation to increased body mass index and race. Pediatrics 2001; 108(2):347-353.7-Kaplowitz PB. Link between body fat and the timing of puberty. Pediatrics 2008;121(3): S208-217.8-Ahmed, ML, Ong KK, Dunger DB. Childhood obesity and the timing of puberty. Trends in Endocrinology & Metabolism 2009; 20(5):237-242.9-Jasik C B, Lustig RH. Adolescent obesity and puberty: the “perfect storm”. Annals of the New York Academy of Sciences 2008;1135(1):265-27910-Carel JC, Leger J. Precocious puberty. New Engl J Med. 2008;358(22):2366-2377.11-Latronico AC, Brito VN, Carel JC. Causes, diagnosis, and treatment of central precocious puberty. The Lancet Diabetes & Endocrinology 2016;4(3):265-274.12-Boyar R, Finkelstein J, Roffwarg H, Kapen S, Weitzman E, Hellman L. Synchronization of augmented luteinizing hormone secretion with sleep during puberty. New Engl J Med. 1972;287(12):582-586.13-Apter D, Bützow TL, Laughlin GA,Yen SS. Gonadotropin-releasing hormone pulse generator activity during pubertal transition in girls: pulsatile and diurnal patterns of circulating gonadotropins. J Clin Endocrinol Metab. 1993;76(4):940-949.14-Neely EK, Hintz RL, Wilson DM, Lee PA, Gautier T, Argente J, Stene M. Normal ranges for immunochemiluminometric gonadotropin assays. J Pediatr. 1995;127(1):40-46.15-Brito VN, Batista MC, Borges, MF, Latronico, AC, Kohek MBF, Thirone ACP, Mendonca BB. Diagnostic value of fluorometric assays in the evaluation of precocious puberty. J Clin Endocrinol Metab. 1999;84(10):3539-3544.16- Willemsen RH, Dunger DB. Normal variation in pubertal timing: genetic determinants in relation to growth and adiposity. In: Puberty from Bench to Clinic. Karger Publishers, 2016. p. 17-35.17-Bordini B, Littlejohn E, Rosenfield RL. Blunted sleep-related luteinizing hormone rise in healthy premenarcheal pubertal girls with elevated body mass index. J Clin Endocrinol Metab. 2009; 94(4):1168-1175.18-McCartney CR, Prendergast KA, Blank SK, Helm KD, Chhabra S, Marshall JC. Maturation of luteinizing hormone (gonadotropin-releasing hormone) secretion across puberty: evidence for altered regulation in obese peripubertal girls. J Clin Endocrinol Metab. 2009; 94(1):56-66.19- McCartney CR, Blank SK, Prendergast KA, Chhabra S, Eagleson CA, Helm KD, Marshall JC. Obesity and sex steroid changes across puberty: evidence for marked hyperandrogenemia in pre-and early pubertal obese girls. J Clin Endocrinol Metab. 2006;92(2):430-436.20-Fu JF, Liang, JF, Zhou XL, Prasad HC, Jin JH, Dong GP,Rose SR. Impact of BMI on gonadorelin‐stimulated LH peak in premenarcheal girls with idiopathic central precocious puberty. Obesity 2015; 23(3):637-643.21-Giabicani E, Allali S, Durand A, Sommet J, Couto-Silva AC, Brauner R. Presentation of 493 consecutive girls with idiopathic central precocious puberty: a single-center study. PloS one 2013; 8(7):e70931.22-Zhao Y, Hou L, Gao HJ, Zhan D, Zhang C, Luo XP. Independent relationship between body mass index and LH peak value of GnRH stimulation test in ICPP girls: A cross-sectional study. Journal of Huazhong University of Science and Technology [Medical Sciences] 2017;37(4):556-562.23- Kim HK, Kee SJ, Seo JY, Yang EM, Chae HJ, Kim CJ. Gonadotropin-releasing hormone stimulation test for precocious puberty. Korean J Lab Med. 2011; 31(4):244-249.24-Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F, Baş F. Reference values for weight, height, head circumference, and body mass index in Turkish children. J Clin Res Pediatr Endocrinol 2015;7(4):280-93.25- WHO Growth Reference 5-19 years:URL: [Last accessed on 07/06/2019].
  • 26-Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arc Dis Child. 1969; 44(235):291-303.27-Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. Stanford University Press, Stanford, 195928- Roa J, García-Galiano D, Castellano JM, Gaytan F, Pinilla L, Tena-Sempere M. Metabolic control of puberty onset: new players, new mechanisms. Molecular and cellular endocrinology 2010;324(1-2): 87-94.29-Aksglaede L, Sørensen K, Petersen JH, Skakkebaek NE, Juul A. Recent decline in age at breast development: the Copenhagen Puberty Study. Pediatrics 2009; 123(5):e932-e939.30- Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics 2002;110(5):903-910.31-Solorzano CMB, McCartney CR. Obesity and the pubertal transition in girls and boys. Reproduction 2010; 140(3):399-410.32-Knudsen KL, Blank SK, Burt‐Solorzano C, Patrie, JT, Chang RJ, Caprio S, McCartney CR. Hyperandrogenemia in obese peripubertal girls: correlates and potential etiological determinants. Obesity 2010; 18(11):2118-2124.33- Apter D, Bützow, T, Laughlin GA,Yen SS. Accelerated 24-hour luteinizing hormone pulsatile activity in adolescent girls with ovarian hyperandrogenism: relevance to the developmental phase of polycystic ovarian syndrome. J Clin Endocrinol Metab. 1994; 79(1):119-125.34- Hassink SG, Sheslow DV, De Lancey E, Opentanova I, Considine RV, Caro JF. Serum leptin in children with obesity: relationship to gender and development. Pediatrics 1996;98(2):201-203.35- Lee HS, Yoon JS, Hwang JS. Luteinizing hormone secretion during gonadotropin-releasing hormone stimulation tests in obese girls with central precocious puberty. J Clin Res Pediatr Endocrinol. 2016; 8(4):392.36-Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. American Heart Journal 2008; 156(1):13-2