Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.

FUJITA, Lívia Grimaldi Abud

Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.

Detalhes bibliográficos
Autor(a) principal:	FUJITA, Lívia Grimaldi Abud
Data de Publicação:	2018
Tipo de documento:	Dissertação
Idioma:	por
Título da fonte:	Biblioteca Digital de Teses e Dissertações da UFTM
Texto Completo:	http://bdtd.uftm.edu.br/handle/tede/658
Resumo:	O teste de monitorização clássico para avaliar efetividade do tratamento da puberdade precoce central (PPC) é realizado com o GnRH agudo e são colhidos LH e FSH a cada 30 minutos de sua administração, até 120 minutos. No entanto, além da aquisição do GnRH ter se tornado difícil, ainda não existe na literatura um consenso sobre valores de corte para os níveis hormonais estimulados que indiquem supressão gonadotrófica. Os valores de corte do LH para diagnóstico de PPC são menos polêmicos, ainda assim, diferentes autores sugerem diferentes valores. Trabalhos anteriormente realizados na UFTM mostraram que esse valor de corte pode variar entre 3,3 e 4,5 UI/L. O objetivo principal desse trabalho é avaliar parâmetros clínicos e laboratoriais que indiquem supressão do eixo gonadotrófico e eficácia do tratamento da PPC com acetato de leuprorrelina de depósito, um análogogo do GnRH, bem como determinar quais níveis hormonais indicam supressão gonadotrófica. Além disso, o teste de efetividade foi testado em sua reprodutibilidade e em relação à necessidade de se estender até 2 horas. Também foi estudado valores de corte para diagnóstico de PPC. Foram estudadas 24 meninas que estavam em acompanhamento no Ambulatório da Disciplina de Endocrinologia da UFTM por diagnóstico clínico e laboratorial de PPC e em tratamento com acetato de leuprorrelina, 3,75 mg, intramuscular, a cada 28 dias. Os parâmetros considerados como eficácia clínica do tratamento foram a regressão ou manutenção dos caracteres sexuais secundários segundo Tanner, a diminuição da velocidade de crescimento (VC), a manutenção ou diminuição da diferença entre a idade óssea e a idade cronológica (ΔIO-IC) e a manutenção ou melhora da previsão de estatura final (PEF). O teste de efetividade foi realizado dosando estradiol basal e LH e FSH antes e após 1 e 2 horas da administração do acetato de leuprorrelina, 3,75 mg. Ele foi repetido com um intervalo de 28 dias em 8 meninas, para avaliar a reprodutibilidade do teste. Além disso, os níveis hormonais dosados no teste, nos diferentes tempos, foram comparados entre si para avaliar a necessidade de estender o teste até 2 horas. Para determinar valores de corte que indiquem diagnóstico de PPC, os testes de estímulo realizados com acetato de leuprorrelina para diagnóstico nas meninas em tratamento foram comparados com os testes de 11 meninas de um grupo controle. A análise estatística mostrou que houve diferença significativa na regressão dos caracteres sexuais segundo Tanner e na redução da VC e o ΔIOIC e a PEF não apresentaram alteração. As principais variáveis utilizadas no teste de efetividade(LH estimulado) foram reprodutíveis e não houve diferença estatística entre os níveis de LH dosados com 1 e 2 horas de teste. Onze meninas apresentaram melhora de todos os parâmetros clínicos avaliados e quando seus testes de efetividade foram comparados aos das demais, foram estabelecidos os valores de corte para o LH após 1 hora ≤ 3,64 UI/L e LH após 2 horas ≤ 6,10 UI/L como indicativos de supressão gonadotrófica. Os valores encontrados para o FSH e razão LH/FSH não foram reprodutíveis ou não alcançaram significância estatística. Quanto aos valores de corte para diagnóstico de PPC, os níveis hormonais compatíveis com ativação gonadotrófica foram estradiol basal > 12,8 pg/ml, LH basal > 0,10 UI/L, LH após 1 hora > 2,66 UI/L e após 2 horas > 3,34 UI/L. Assim, os resultados do trabalho mostraram que é possível colher o LH apenas com uma hora após a administração da leuprorrelina e que valores > 3,64 UI/L indicam necessidade de ajuste da medicação. Além disso, a coleta do FSH durante o teste de efetividade não é necessária. Em relação ao diagnóstico de PPC, os valores de corte encontrados no trabalho foram semelhantes aos resultados de estudos previamente realizados na UFTM.

Metadados do item

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spelling	Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.Parameters of efficacy of the treatment with GnRH analogues in children with precocious pubertyPuberdade.Puberdade Precoce Central.Hormônio Liberador de Gonadotropina.Análogos de GnRHPuberty.Central Precocious Puberty.Gonadotropin Releasing Hormone.GnRH analogues.EndocrinologiaO teste de monitorização clássico para avaliar efetividade do tratamento da puberdade precoce central (PPC) é realizado com o GnRH agudo e são colhidos LH e FSH a cada 30 minutos de sua administração, até 120 minutos. No entanto, além da aquisição do GnRH ter se tornado difícil, ainda não existe na literatura um consenso sobre valores de corte para os níveis hormonais estimulados que indiquem supressão gonadotrófica. Os valores de corte do LH para diagnóstico de PPC são menos polêmicos, ainda assim, diferentes autores sugerem diferentes valores. Trabalhos anteriormente realizados na UFTM mostraram que esse valor de corte pode variar entre 3,3 e 4,5 UI/L. O objetivo principal desse trabalho é avaliar parâmetros clínicos e laboratoriais que indiquem supressão do eixo gonadotrófico e eficácia do tratamento da PPC com acetato de leuprorrelina de depósito, um análogogo do GnRH, bem como determinar quais níveis hormonais indicam supressão gonadotrófica. Além disso, o teste de efetividade foi testado em sua reprodutibilidade e em relação à necessidade de se estender até 2 horas. Também foi estudado valores de corte para diagnóstico de PPC. Foram estudadas 24 meninas que estavam em acompanhamento no Ambulatório da Disciplina de Endocrinologia da UFTM por diagnóstico clínico e laboratorial de PPC e em tratamento com acetato de leuprorrelina, 3,75 mg, intramuscular, a cada 28 dias. Os parâmetros considerados como eficácia clínica do tratamento foram a regressão ou manutenção dos caracteres sexuais secundários segundo Tanner, a diminuição da velocidade de crescimento (VC), a manutenção ou diminuição da diferença entre a idade óssea e a idade cronológica (ΔIO-IC) e a manutenção ou melhora da previsão de estatura final (PEF). O teste de efetividade foi realizado dosando estradiol basal e LH e FSH antes e após 1 e 2 horas da administração do acetato de leuprorrelina, 3,75 mg. Ele foi repetido com um intervalo de 28 dias em 8 meninas, para avaliar a reprodutibilidade do teste. Além disso, os níveis hormonais dosados no teste, nos diferentes tempos, foram comparados entre si para avaliar a necessidade de estender o teste até 2 horas. Para determinar valores de corte que indiquem diagnóstico de PPC, os testes de estímulo realizados com acetato de leuprorrelina para diagnóstico nas meninas em tratamento foram comparados com os testes de 11 meninas de um grupo controle. A análise estatística mostrou que houve diferença significativa na regressão dos caracteres sexuais segundo Tanner e na redução da VC e o ΔIOIC e a PEF não apresentaram alteração. As principais variáveis utilizadas no teste de efetividade(LH estimulado) foram reprodutíveis e não houve diferença estatística entre os níveis de LH dosados com 1 e 2 horas de teste. Onze meninas apresentaram melhora de todos os parâmetros clínicos avaliados e quando seus testes de efetividade foram comparados aos das demais, foram estabelecidos os valores de corte para o LH após 1 hora ≤ 3,64 UI/L e LH após 2 horas ≤ 6,10 UI/L como indicativos de supressão gonadotrófica. Os valores encontrados para o FSH e razão LH/FSH não foram reprodutíveis ou não alcançaram significância estatística. Quanto aos valores de corte para diagnóstico de PPC, os níveis hormonais compatíveis com ativação gonadotrófica foram estradiol basal > 12,8 pg/ml, LH basal > 0,10 UI/L, LH após 1 hora > 2,66 UI/L e após 2 horas > 3,34 UI/L. Assim, os resultados do trabalho mostraram que é possível colher o LH apenas com uma hora após a administração da leuprorrelina e que valores > 3,64 UI/L indicam necessidade de ajuste da medicação. Além disso, a coleta do FSH durante o teste de efetividade não é necessária. Em relação ao diagnóstico de PPC, os valores de corte encontrados no trabalho foram semelhantes aos resultados de estudos previamente realizados na UFTM.The classic monitoring test to evaluate effectiveness of central precocious puberty (CPP) treatment is performed with acute GnRH and LH and FSH are collected every 30 minutes from its administration, up to 120 minutes. However, besides the acquisition of GnRH has become difficult, there is still no consensus in the literature on cut-off values for stimulated hormone levels indicating gonadotropic suppression. The cut-off values of LH for the diagnosis of CPP are less controversial, yet different authors suggest different values. Previous studies on UFTM has shown that this cutoff value can vary between 3.3 and 4.5 IU / L. The main objective of this study is to evaluate clinical and laboratory parameters that indicate suppression of the gonadotrophic axis and efficacy of the treatment of CPP with depot leuprolid acetate, a GnRH analog, as well as to determine which hormonal levels indicate gonadotrophic suppression. In addition, the effectiveness test was analyzed for its reproducibility and the need to be extended up to 2 hours. It has also been studied cutoff values for diagnosis of CPP. In this study were included twenty-four girls who were followed up at the Ambulatory of the Discipline of Endocrinology of UFTM for clinical and laboratory diagnosis of CPP under treatment with leuprorelin acetate, 3.75 mg, intramuscular every 28 days. The parameters considered as clinical efficacy of the treatment were regression or maintenance of secondary sexual characteristics according to Tanner, the decrease in growth velocity (GV), maintenance or decrease of the difference between bone age and chronological age (ΔBA-CA) and the maintenance or improvement of the final height prediction (FHP). The effectiveness test was carried out by dosing basal estradiol also FSH and LH at three time points: before and 1 and 2 hours after administration of leuprolide acetate 3.75 mg. It was repeated with a 28-day interval in 8 girls to evaluate the reproducibility of the test. In addition, the hormone levels measured in the test at different times were compared to each other to evaluate the need to extend the test up to 2 hours. To determine cutoff values that indicate diagnosis of CPP, the stimulus tests performed with leuprorelin acetate for diagnosis in the girls being treated were compared with the tests of 11 girls from a control group. Statistical analysis showed that there was a significant difference in the regression of the sexual characters according to Tanner and in the reduction of the GV. The ΔBA-CA and the FHP did not present alteration. The main variables used in the effectiveness test (stimulated LH) were reproducible and there was no statistical differencebetween the levels of LH dosed with 1 and 2 hours of test. Eleven girls showed improvement in all clinical parameters evaluated and when their effectiveness tests were compared to the others, the cutoff values were set to LH after 1 hour ≤ 3.64 IU / L and LH after 2 hours ≤ 6.10 IU /L as indicative of gonadotropic suppression. The values found for FSH and LH / FSH ratio were not reproducible or did not reach statistical significance. Regarding cut-off values for the diagnosis of PPC, hormonal levels compatible with gonadotropic activation were baseline estradiol> 12.8 pg / ml, baseline LH> 0.10 IU / L, LH after 1 hour> 2.66 IU / L and after 2 hours> 3.34 IU / L. Thus, the results of the study showed that it is possible to collect LH only one hour after the administration of leuprorelin and that values > 3.64 IU / L indicate a need for adjustment of the medication. In addition, collection of FSH during the effectiveness test is not required. 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Journal of Pediatric Endocrinology & Metabolism, v. 21, n. 6, p. 533-538, 2008.http://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFTMinstname:Universidade Federal do Triangulo Mineiro (UFTM)instacron:UFTM2019-05-22T04:00:27Zoai:bdtd.uftm.edu.br:tede/658Biblioteca Digital de Teses e Dissertaçõeshttp://bdtd.uftm.edu.br/PUBhttp://bdtd.uftm.edu.br/oai/requestbdtd@uftm.edu.br\|\|bdtd@uftm.edu.bropendoar:2019-05-22T04:00:27Biblioteca Digital de Teses e Dissertações da UFTM - Universidade Federal do Triangulo Mineiro (UFTM)false
dc.title.none.fl_str_mv	Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce. Parameters of efficacy of the treatment with GnRH analogues in children with precocious puberty
title	Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.
spellingShingle	Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce. FUJITA, Lívia Grimaldi Abud Puberdade. Puberdade Precoce Central. Hormônio Liberador de Gonadotropina. Análogos de GnRH Puberty. Central Precocious Puberty. Gonadotropin Releasing Hormone. GnRH analogues. Endocrinologia
title_short	Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.
title_full	Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.
title_fullStr	Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.
title_full_unstemmed	Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.
title_sort	Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.
author	FUJITA, Lívia Grimaldi Abud
author_facet	FUJITA, Lívia Grimaldi Abud
author_role	author
dc.contributor.none.fl_str_mv	BORGES, Maria de Fátima 25537032600 http://lattes.cnpq.br/3192369967083138
dc.contributor.author.fl_str_mv	FUJITA, Lívia Grimaldi Abud
dc.subject.por.fl_str_mv	Puberdade. Puberdade Precoce Central. Hormônio Liberador de Gonadotropina. Análogos de GnRH Puberty. Central Precocious Puberty. Gonadotropin Releasing Hormone. GnRH analogues. Endocrinologia
topic	Puberdade. Puberdade Precoce Central. Hormônio Liberador de Gonadotropina. Análogos de GnRH Puberty. Central Precocious Puberty. Gonadotropin Releasing Hormone. GnRH analogues. Endocrinologia
description	O teste de monitorização clássico para avaliar efetividade do tratamento da puberdade precoce central (PPC) é realizado com o GnRH agudo e são colhidos LH e FSH a cada 30 minutos de sua administração, até 120 minutos. No entanto, além da aquisição do GnRH ter se tornado difícil, ainda não existe na literatura um consenso sobre valores de corte para os níveis hormonais estimulados que indiquem supressão gonadotrófica. Os valores de corte do LH para diagnóstico de PPC são menos polêmicos, ainda assim, diferentes autores sugerem diferentes valores. Trabalhos anteriormente realizados na UFTM mostraram que esse valor de corte pode variar entre 3,3 e 4,5 UI/L. O objetivo principal desse trabalho é avaliar parâmetros clínicos e laboratoriais que indiquem supressão do eixo gonadotrófico e eficácia do tratamento da PPC com acetato de leuprorrelina de depósito, um análogogo do GnRH, bem como determinar quais níveis hormonais indicam supressão gonadotrófica. Além disso, o teste de efetividade foi testado em sua reprodutibilidade e em relação à necessidade de se estender até 2 horas. Também foi estudado valores de corte para diagnóstico de PPC. Foram estudadas 24 meninas que estavam em acompanhamento no Ambulatório da Disciplina de Endocrinologia da UFTM por diagnóstico clínico e laboratorial de PPC e em tratamento com acetato de leuprorrelina, 3,75 mg, intramuscular, a cada 28 dias. Os parâmetros considerados como eficácia clínica do tratamento foram a regressão ou manutenção dos caracteres sexuais secundários segundo Tanner, a diminuição da velocidade de crescimento (VC), a manutenção ou diminuição da diferença entre a idade óssea e a idade cronológica (ΔIO-IC) e a manutenção ou melhora da previsão de estatura final (PEF). O teste de efetividade foi realizado dosando estradiol basal e LH e FSH antes e após 1 e 2 horas da administração do acetato de leuprorrelina, 3,75 mg. Ele foi repetido com um intervalo de 28 dias em 8 meninas, para avaliar a reprodutibilidade do teste. Além disso, os níveis hormonais dosados no teste, nos diferentes tempos, foram comparados entre si para avaliar a necessidade de estender o teste até 2 horas. Para determinar valores de corte que indiquem diagnóstico de PPC, os testes de estímulo realizados com acetato de leuprorrelina para diagnóstico nas meninas em tratamento foram comparados com os testes de 11 meninas de um grupo controle. A análise estatística mostrou que houve diferença significativa na regressão dos caracteres sexuais segundo Tanner e na redução da VC e o ΔIOIC e a PEF não apresentaram alteração. As principais variáveis utilizadas no teste de efetividade(LH estimulado) foram reprodutíveis e não houve diferença estatística entre os níveis de LH dosados com 1 e 2 horas de teste. Onze meninas apresentaram melhora de todos os parâmetros clínicos avaliados e quando seus testes de efetividade foram comparados aos das demais, foram estabelecidos os valores de corte para o LH após 1 hora ≤ 3,64 UI/L e LH após 2 horas ≤ 6,10 UI/L como indicativos de supressão gonadotrófica. Os valores encontrados para o FSH e razão LH/FSH não foram reprodutíveis ou não alcançaram significância estatística. Quanto aos valores de corte para diagnóstico de PPC, os níveis hormonais compatíveis com ativação gonadotrófica foram estradiol basal > 12,8 pg/ml, LH basal > 0,10 UI/L, LH após 1 hora > 2,66 UI/L e após 2 horas > 3,34 UI/L. Assim, os resultados do trabalho mostraram que é possível colher o LH apenas com uma hora após a administração da leuprorrelina e que valores > 3,64 UI/L indicam necessidade de ajuste da medicação. Além disso, a coleta do FSH durante o teste de efetividade não é necessária. Em relação ao diagnóstico de PPC, os valores de corte encontrados no trabalho foram semelhantes aos resultados de estudos previamente realizados na UFTM.
publishDate	2018
dc.date.none.fl_str_mv	2018-05-11 2019-05-21T13:17:14Z
dc.type.status.fl_str_mv	info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv	info:eu-repo/semantics/masterThesis
format	masterThesis
status_str	publishedVersion
dc.identifier.uri.fl_str_mv	FUJITA, Lívia Grimaldi Abud. Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce. 2018. 163f. Dissertação (Mestrado em Ciências da Saúde) - Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Triângulo Mineiro, Uberaba, 2018. http://bdtd.uftm.edu.br/handle/tede/658
identifier_str_mv	FUJITA, Lívia Grimaldi Abud. Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce. 2018. 163f. Dissertação (Mestrado em Ciências da Saúde) - Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Triângulo Mineiro, Uberaba, 2018.
url	http://bdtd.uftm.edu.br/handle/tede/658
dc.language.iso.fl_str_mv	por
language	por
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Parâmetros de eficácia do tratamento com análogos do GnRH em crianças portadoras de puberdade precoce.

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