Особенности течения, диагностики и терапии детей с прежде­временным половым развитием при гипоталамической гамартоме и идиопатической форме

Идиопатическая форма является наиболее распространенной среди всех центральных форм ППР (от 30 до 70%) и встречается преимущественно у девочек. Гипоталамическая гамартома (ГГ), как причина ППР, встречается реже, однако это наиболее часто выявляемое образование у детей обоего пола с манифестацией истинного ППР до 3 лет. Проблемы диагностики и терапии различных форм центрального ППР занимают важное место в практике педиатра-эндокринолога. Доказана эффективность терапии аналогами люлиберина в плане увеличения конечного роста и подавления прогрессирования полового развития, показана обратимость воздействия аналогов люлиберина на систему гонадостата. Тем не менее продолжают обсуждаться особенности течения, принципы лечения и эффективности терапии различных этиологических вариантов центрального ППР. Изучаются последствия лечения аналогами люлиберина: процессы восстановления нормального пубертата, влияние на репродуктивную функцию, массу тела и зависимость терапии от формы центрального ППР. В статье представлены данные об особенностях течения заболевания и эффективности терапии у детей с идиопатической формой гонадотропинзависимого ППР и ППР, ассоциированного с гамартомой.

преждевременное половое развитие, гипоталамическая гамартома, идиопатическое центральное преждевременное половое развитие, аналоги люлиберина

1. Дедов И.И., Семичева Т.В., Петеркова В.А. Половое развитие: норма и патология. М: Колор Ит Студио 2002; 64-68.

2. Дедов И.И., Петеркова В.А. Руководство по детской эндокринологии. М: Универсум паблишинг 2006; 361.

3. Carel J.C., Eugster E.A., Rogol A. Consensus statement on the use ofgonadotropin-releasing hormone analogs in children. J Pediatr (Paris, France) 2009; 123: 4: 752-762.

4. Lazar L., Padoa A., Phillip M. Growth pattern and final height after cessation of gonadotropin-suppressive therapy in girls with central sexual precocity. J Clin Endocrinol Metab 2007; 92: 9: 3483-3489.

5. Paul D., Conte F.A., Grumbach M.M., Kaplan S.L. Long-term effect of gonadotropin-releasing hormone agonist therapy on final and near-final height in 26 children with true precocious puberty treated at a median age of less than 5 years. J Clin Endocrinol Metab 1995; 80: 2: 546-551.

6. Bertelloni S., Baroncelli G.I., Ferdeghini M. Final height, gonadal function and bone mineral density of adolescent males with central precocious puberty after therapy with gonadotropin-releasing hormone analogues. J Pediatr (Pisa, Italy) 2000; 159: 5: 369-374.

7. Klein K.O., Barnes K.M., Jones J.V., Feuillan P.P., Cutler G.B.Jr. Increased final height in precocious puberty after long-term treatment with LHRH agonists: the National Institutes of Health experience. J Clin Endocrinol Metab 2001; 86 : 10: 4711-4716.

8. Arrigo T., Cisternino M., Galluzzi F. et al. Analysis of the factors affecting auxological response to GnRH agonist treatment and final height outcome in girls with idiopathic central precocious puberty. Eur J Endocrinol 1999; 141: 2: 140-144.

9. Mul D., Bertelloni S., Carel J.C., Saggese G., Chaussain J.L., Oostdijk W. Effect of gonadotropin-releasing hormone agonist treatment in boys with central precocious puberty: final height results. Hormon Res 2002; 58: 1: 1-7.

10. Cassio A., Bal M.O., Orsini L.F. Reproductive outcome in patients treated and not treated for idiopathic early puberty: long-term results of a randomized trial in adults. J Pediatr 2006; 149: 4: 532-536.

11. Feuillan P.P., Jones J.V., Barnes K.M. Boys with precocious puberty due to hypothalamic hamartoma: reproductive axis after discontinuation of gonadotropin-releasing hormone analog therapy. J Clin Endocrinol Metab (USA) 2000; 85: 11: 4036-4038.

12. Tanaka T., Niimi H., Matsuo N. Results of long-termfollow-up after treatment of central precocious puberty with leuprorelin acetate: evaluation of effectiveness of treatment and recovery of gonadal function. J Clin Endocrinol Metab (Japan) 2005; 90: 3: 1371-1376.

13. Arrigo T., De Luca F., Antoniazzi F. Menstrual cycle pattern during the first gynaecological years in girls with precocious puberty following gonadotropin-releasing hormone analogue treatment. J Pediatr (Italy) 2007; 166: 1: 73-74.

14. Heger S., Partsch C.J., Sippell W.G. Long-term outcome after depot gonadotropin-releasing hormone agonist treatment of central precocious puberty: final height, body proportions, body composition, bone mineral density, and reproductive function. J Clin Endocrinol Metab 1999; 84: 12: 4583-4590.

15. Albanese A., Hopper N.W. Suppression of menstruation in adolescents with severe learning disabilities. Arch Dis Child 2007; 92: 7: 629-632.

16. Teilmann G., Boas M., Petersen J.H. et al. Early pituitary gonadal activation before clinical signs of puberty in 5- to 8-year-old adopted girls: a study of 99 foreign adopted girls and 93 controls. J Clin Endocrinol Metab 2007; 92 : 7: 2538-2544.

17. Tanaka T., Niimi H., Matsuo N. et al. Results of long-term follow-up after treatment of central precocious puberty with leuprorelin acetate: evaluation of effectiveness of treatment and recovery of gonadal function. The TAP-144-SR Japanese Study Group on Central Precocious Puberty. J Clin Endocrinol Metab 2005; 90: 3: 1371-1376.

18. Pasquino A.M., Pucarelli I., Accardo F., Demiraj V., Segni M., Di Nardo R. Long-term observation of 87 girls with idiopathic central precocious puberty treated with gonadotropinreleasing hormone analogs: impact on adult height, body mass index, bone mineral content, and reproductive function. J Clin Endocrinol Metab 2008; 93 : 1: 190-195.

19. Arrigo T., De Luca F., Antoniazzi F. et al. Reduction of baseline body mass index under gonadotropin-suppressive therapy in girls with idiopathic precocious puberty. Eur J Endocrinol 2004; 150 : 4: 533-537.

20. Messaaoui A., Massa G., Tenoutasse S. et al. Treatment of central precocious puberty with gonadotropin-releasing hormone agonist (triptorelin) in girls: breast development, skeletal maturation, height and weight evolution during and after treatment. Rev Med Brux 2005; 26: 1: 27-32.

21. Sørensen K., Mouritsen A., Mogensen S.S., 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: 8: 3736-3744.

22. Poomthavorn P., Suphasit R., Mahachoklertwattana P. Adult height, body mass index and time of menarche of girls with idiopathic central precocious puberty after gonadotropin-releasing hormone analogue treatment. Gynecol Endocrinol 2011; 27: 8: 524-528.

23. Harada K., Yoshida J., Wakabayashi T., Okabe H., Sugita K. A super long-acting LH-RH analogue induces regression of hypothalamic hamartoma associated with precocious puberty. Acta Neurochir 1995; 137: 102-105.

24. Mul D., Versluis-den Bieman H.J., Slijper F.M. Psychological assessments before and after treatment of early puberty in adopted children. J Acta Paediatr 2001; 90: 9: 965-971.

25. Svend E.M., Flemming W.L. Psychological aspects of precocious puberty. J Acla Pacdopsychiatrica 1992; 55: 45-49.

26. Tremblay L., Frigon J.Y. Precocious puberty in adolescent girls: a biomarker of later psychosocial adjustment problems. J Child Psychiatry Hum Dev 2005; 36: 1: 73-94.

27. Baumann D.A., Landolt M.A., Wetterwald R. Psychological evaluation of young women after medical treatment for central precocious puberty. J Horm Res 2001; 56: 1-2: 45-50.

28. Feuillan P.P., Jones J.V., Barnes K., Oerter-Klein K., Cutler G.B.Jr. Reproductive axis after discontinuation of gonadotropin-releasing hormone analog treatment of girls with precocious puberty: long term follow-up comparing girls with hypothalamic hamartoma to those with idiopathic precocious puberty. J Clin Endocrinol Metab 1999; 84: 1: 44-49.

29. Trivin C., Couto-Silva A.C., Sainte-Rose C., Chemaitilly W., Kalifa C., Doz F., Zerah M., Brauner R. Presentation and evolution of organic central precocious puberty according to the type of CNS lesion. Clin Endocrinol (Oxf) 2006; 65: 2: 239-245.

30. Couto-Silva A.C., Adan L., Trivin C., Brauner R. Adult height in advanced puberty with or without gonadotropin hormone releasing hormone analog treatment. J Pediatr Endocrinol Metab 2002; 15: 3: 297-305.

31. Jean-Claude C., Lahlou N., Roger M. Precocious puberty and statural growth. J Human Reprod Update 2004; 10: 2: e135-e147.