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Blood pressure in girls with central precocious puberty receiving GnRH analogue therapy

  • Naama Fisch-Shvalb ORCID logo EMAIL logo , Hadas Alfandary-Harani , Liora Lazar , Miriam Davidovits , Nir Shvalb , Sharon Demol-Eliaz , Michal Yackobovitch-Gavan and Liat de Vries
Published/Copyright: July 3, 2023
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 36 Issue 8

Abstract

Objectives

Case reports show hypertension in children treated with GnRH analogues for central precocious puberty (CPP). However, relevant data on blood pressure are scarce. We aimed to evaluate blood pressure (BP) among girls with idiopathic CPP and early-onset puberty before and during GnRH analogue therapy; and to examine associations of blood pressure with clinical parameters.

Methods

For this retrospective longitudinal cohort study, demographic, anthropometric, clinical, and laboratory data were collected from electronic files. The study group included 112 girls with idiopathic CPP or early-onset puberty followed in a tertiary pediatric endocrinology institute, and a control group of 37 healthy pre-pubertal girls. The main outcome measures were BP percentile, before, and during treatment with GnRH analogue.

Results

At baseline, similar proportions of the study and control groups had BP values>90th percentile: 64 (53 %) and 17 (46 %), respectively (p=0.57). The mean systolic and diastolic BP percentiles measured under treatment remained unchanged. In the study group, baseline BP>90th percentile compared to normal baseline BP was associated with lower birthweight and a higher body mass index-standard deviation score: 2,821 ± 622 vs. 3,108 ± 485 g and 1.0 ± 0.7 vs. 0.70 ± 0.8, respectively, p=0.01 for both.

Conclusions

GnRH analogue therapy for precocious or early puberty was not associated with increased blood pressure. The stability of mean blood pressure percentile during treatment is reassuring.

Keywords: blood pressure; GnRHa; hypertension; precocious puberty
Corresponding author: Naama Fisch-Shvalb, MD, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, The Jesse Z. and Lea Shafer Institute for Endocrinology and Diabetes, 14 Kaplan Street, Petach Tikva 4920235, Israel; and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, Phone: +972 3 9259018, Fax: +972 3 9253836, E-mail:

Acknowledgments

The authors wish to thank Pearl Lilos for the statistical analysis.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no competing of interest.

  4. Informed consent: Informed consent was not required in this study.

  5. Ethical approval: The local Institutional Review Board reviewed and approved the study.

References

1. Kaplowitz, P, Bloch, C, Section on Endocrinology, American Academy of Pediatrics. Evaluation and referral of children with signs of early puberty. Pediatrics 2016;137. https://doi.org/10.1542/peds.2015-3732.Search in Google Scholar PubMed

2. Carel, JC, Eugster, EA, Rogol, A, Ghizzoni, L, Palmert, MR, ESPE-LWPES GnRH Analogs Consensus Conference Group, et al.. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics 2009;123:e752–62. https://doi.org/10.1542/peds.2008-1783.Search in Google Scholar PubMed

3. Product information: TRELSTAR (R) IM injection, triptorelin pamoate IM injection. Morristown, NJ: Watson Pharma, Inc; 2010.Search in Google Scholar

4. Calcaterra, V, Mannarino, S, Corana, G, Codazzi, AC, Mazzola, A, Brambilla, P, et al.. Hypertension during therapy with triptorelin in a girl with precocious puberty. Indian J Pediatr 2013;80:884–5. https://doi.org/10.1007/s12098-012-0898-2.Search in Google Scholar PubMed

5. Palma, L, Gaudino, R, Cavarzere, P, Antoniazzi, F. Does the risk of arterial hypertension increase in the course of triptorelin treatment? J Pediatr Endocrinol Metab 2020;33:449–52. https://doi.org/10.1515/jpem-2018-0210.Search in Google Scholar PubMed

6. Sifaki, L, Cachat, F, Theintz, G, Chehade, H. Transient arterial hypertension induced by gonadotropin-releasing hormone agonist treatment for central precocious puberty. Front Pediatr 2019;7:74. https://doi.org/10.3389/fped.2019.00074.Search in Google Scholar PubMed PubMed Central

7. Hembree, WC, Cohen-Kettenis, PT, Gooren, L, Hannema, SE, Meyer, WJ, Murad, MH, et al.. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2017;102:3869–903. https://doi.org/10.4158/1934-2403-23.12.1437.Search in Google Scholar PubMed

8. Sørensen, K, Mouritsen, A, Mogensen, SS, Aksglaede, L, Juul, A. Insulin sensitivity and lipid profiles in girls with central precocious puberty before and during gonadal suppression. J Clin Endocrinol Metab 2010;95:3736–44. https://doi.org/10.1210/jc.2010-0731.Search in Google Scholar PubMed

9. Day, FR, Elks, CE, Murray, A, Ong, KK, Perry, JR. Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study. Sci Rep 2015;5:11208. https://doi.org/10.1038/srep11208.Search in Google Scholar PubMed PubMed Central

10. Maher, GM, Ryan, L, McCarthy, FP, Hughes, A, Park, C, Fraser, A, et al.. Puberty timing and markers of cardiovascular structure and function at 25 years: a prospective cohort study. BMC Med 2021;19:78. https://doi.org/10.1186/s12916-021-01949-y.Search in Google Scholar PubMed PubMed Central

11. Liker, HR, Barnes, KM, Comite, F, Hench, KD, Loriaux, DL, Cutler, GBJr, et al.. Blood pressure and body size in precocious puberty. Acta Paediatr Scand 1988;77:294–8. https://doi.org/10.1111/j.1651-2227.1988.tb10645.x.Search in Google Scholar PubMed

12. Neeman, B, Bello, R, Lazar, L, Phillip, M, de Vries, L. Central precocious puberty as a presenting sign of nonclassical congenital adrenal hyperplasia: clinical characteristics. J Clin Endocrinol Metab 2019;104:2695–700. https://doi.org/10.1210/jc.2018-02605.Search in Google Scholar PubMed

13. Lazar, L, Kauli, R, Pertzelan, A, Phillip, M. 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 2002;87:2090–4. https://doi.org/10.1210/jcem.87.5.8481.Search in Google Scholar PubMed

14. Kuczmarski, RJ, Ogden, CL, Guo, SS, Grummer-Strawn, LM, Flegal, KM, Mei, Z, et al.. 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11 2002;314:1–190.Search in Google Scholar

15. Rosner, B, Prineas, R, Loggie, J, Daniels, SR. Percentiles for body mass index in U.S. children 5 to 17 years of age. J Pediatr 1998;132:211–22. https://doi.org/10.1016/s0022-3476(98)70434-2.Search in Google Scholar PubMed

16. Marshall, WA, Tanner, JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291–303. https://doi.org/10.1136/adc.44.235.291.Search in Google Scholar PubMed PubMed Central

17. Flynn, JT, Kaelber, DC, Baker-Smith, CM, Blowey, D, Carroll, AE, Daniels, SR, et al.. Subcommittee on screening and management of high blood pressure in children clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140. https://doi.org/10.1542/peds.2017-1904.Search in Google Scholar PubMed

18. Rosner, B, Cook, N, Portman, R, Daniels, S, Falkner, B. Determination of blood pressure percentiles in normal-weight children: some methodological issues. Am J Epidemiol 2008;167:653–66. https://doi.org/10.1093/aje/kwm348.Search in Google Scholar PubMed

19. Condren, M, Carter, J, Mushtaq, N, Puckett, S, Kezbers, K, Sabet, S, et al.. The impact of new guidelines on the prevalence of hypertension in children: a cross-sectional evaluation. J Clin Hypertens 2019;21:510–5. https://doi.org/10.1111/jch.13512.Search in Google Scholar PubMed PubMed Central

20. Bell, CS, Samuel, JP, Samuels, JA. Prevalence of hypertension in children. Hypertension 2019;73:148–52. https://doi.org/10.1161/hypertensionaha.118.11673.Search in Google Scholar PubMed PubMed Central

21. Sharma, AK, Metzger, DL, Rodd, CJ. Prevalence and severity of high blood pressure among children based on the 2017 American Academy of Pediatrics guidelines. JAMA Pediatr 2018;172:557–65. https://doi.org/10.1001/jamapediatrics.2018.0223.Search in Google Scholar PubMed PubMed Central

22. Kavey, RE, Kveselis, DA, Atallah, N, Smith, FC. White coat hypertension in childhood: evidence for end-organ effect. J Pediatr 2007;150:491–497. 208 Swartz SJ, Srivaths PR, Croix B, Feig DI. Cost-effectiveness of ambulatory blood pressure monitoring in the initial evaluation of hypertension in children. Pediatrics. 2008;122 (6):1177–1181.10.1542/peds.2007-3432Search in Google Scholar PubMed

23. Platschek, A, Steinkamm, S, Tokarski, W, Graf, C. The impact of repeated blood pressure measurements on detecting hypertension in children and youths. Biomed Hum Kinet 2010;2:42. https://doi.org/10.2478/v10101-010-0011-0.Search in Google Scholar

24. Widén, E, Silventoinen, K, Sovio, U, Ripatti, S, Cousminer, DL, Hartikainen, AL, et al.. Pubertal timing and growth influences cardiometabolic risk factors in adult males and females. Diabetes Care 2012;35:850–6. https://doi.org/10.2337/dc11-1365.Search in Google Scholar PubMed PubMed Central

25. Juul, F, Chang, VW, Brar, P, Parekh, N. Birth weight, early life weight gain and age at menarche: a systematic review of longitudinal studies. Obes Rev 2017;18:1272–88. https://doi.org/10.1111/obr.12587.Search in Google Scholar PubMed

26. Freedman, DS, Khan, LK, Serdula, MK, Dietz, WH, Srinivasan, SR, Berenson, GS. Bogalusa heart study. The relation of menarcheal age to obesity in childhood and adulthood: the Bogalusa heart study. BMC Pediatr 2003;3:3. https://doi.org/10.1186/1471-2431-3-3.Search in Google Scholar PubMed PubMed Central

27. Davies, AA, Smith, GD, May, MT, Ben-Shlomo, Y. Association between birth weight and blood pressure is robust, amplifies with age, and may be underestimated. Hypertension 2006;48:431. https://doi.org/10.1161/01.hyp.0000236551.00191.61.Search in Google Scholar

28. Hovi, P, Vohr, B, Ment, LR, Doyle, LW, McGarvey, L, Morrison, KM, et al.. APIC Adults Born Preterm International Collaboration. Blood pressure in young adults born at very low birth weight: adults born preterm international collaboration. Hypertension 2016;68:880–7. https://doi.org/10.1161/hypertensionaha.116.08167.Search in Google Scholar

29. Theodore, RF, Broadbent, J, Nagin, D, Ambler, A, Hogan, S, Ramrakha, S, et al.. Childhood to early-midlife systolic blood pressure trajectories: early-life predictors, effect modifiers, and adult cardiovascular outcomes. Hypertension 2015;66:1108–15. https://doi.org/10.1161/hypertensionaha.115.05831.Search in Google Scholar PubMed PubMed Central

30. Várbíró, S, Nádasy, GL, Monos, E, Acs, N, Vajo, Z, Székács, B. Sex hormone replacement therapy reverses decreased venous distensibility in pharmacologically ovariectomized rats. Menopause 2001;8:204–9. https://doi.org/10.1097/00042192-200105000-00010.Search in Google Scholar PubMed

Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jpem-2023-0118).

Received: 2023-03-15
Accepted: 2023-06-16
Published Online: 2023-07-03
Published in Print: 2023-08-28

© 2023 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Metabolic risk factors in prepubertal and pubertal patients with overweight and obesity
  4. Blood pressure in girls with central precocious puberty receiving GnRH analogue therapy
  5. Norethindrone dosing for adequate menstrual suppression in adolescents
  6. Apparent diffusion coefficient (ADC) measurements and morphometric evaluation of the cranium in age-matched children with central precocious puberty
  7. Characteristics of vitamin D deficiency hypocalcemia inpatient admissions at a single tertiary center
  8. Early pregnancy exposure of maternal triglyceride levels and its effects on birth weight
  9. Evaluation of the clinical, biochemical, and genetic presentation of neonatal and adult-onset 5,10-methylene tetrahydrofolate reductase (MTHFR) deficiency in patients from Pakistan
  10. Congenital hypothyroidism in Bogotá, Colombia: a current description (2015–2021)
  11. Case Reports
  12. Case report: mitochondrial diabetes mellitus in a Chinese family due to m.3243A>G
  13. Novel pathogenic variant of DICER1 in an adolescent with multinodular goiter, ovarian Sertoli–Leydig cell tumor and pineal parenchymal tumor of intermediate differentiation
  14. Fibroblast growth factor 23 levels in cord and peripheral blood during early neonatal period as possible predictors of affected offspring of X-linked hypophosphatemic rickets: report of three female cases from two pedigrees
  15. A rare cause of hyperphenylalaninemia: four cases from a single family with DNAJC12 deficiency
  16. The benefit of rhGH therapy in a Chinese child with 12q14 microdeletion syndrome: a case report
  17. Adjustment of octreotide dose given via insulin pump based on continuous glucose monitoring (CGM) in a child with congenital hyperinsulinism
https://doi.org/10.1515/jpem-2023-0118
Keywords for this article
blood pressure; GnRHa; hypertension; precocious puberty

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Metabolic risk factors in prepubertal and pubertal patients with overweight and obesity
  4. Blood pressure in girls with central precocious puberty receiving GnRH analogue therapy
  5. Norethindrone dosing for adequate menstrual suppression in adolescents
  6. Apparent diffusion coefficient (ADC) measurements and morphometric evaluation of the cranium in age-matched children with central precocious puberty
  7. Characteristics of vitamin D deficiency hypocalcemia inpatient admissions at a single tertiary center
  8. Early pregnancy exposure of maternal triglyceride levels and its effects on birth weight
  9. Evaluation of the clinical, biochemical, and genetic presentation of neonatal and adult-onset 5,10-methylene tetrahydrofolate reductase (MTHFR) deficiency in patients from Pakistan
  10. Congenital hypothyroidism in Bogotá, Colombia: a current description (2015–2021)
  11. Case Reports
  12. Case report: mitochondrial diabetes mellitus in a Chinese family due to m.3243A>G
  13. Novel pathogenic variant of DICER1 in an adolescent with multinodular goiter, ovarian Sertoli–Leydig cell tumor and pineal parenchymal tumor of intermediate differentiation
  14. Fibroblast growth factor 23 levels in cord and peripheral blood during early neonatal period as possible predictors of affected offspring of X-linked hypophosphatemic rickets: report of three female cases from two pedigrees
  15. A rare cause of hyperphenylalaninemia: four cases from a single family with DNAJC12 deficiency
  16. The benefit of rhGH therapy in a Chinese child with 12q14 microdeletion syndrome: a case report
  17. Adjustment of octreotide dose given via insulin pump based on continuous glucose monitoring (CGM) in a child with congenital hyperinsulinism
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