NORMALI SOVRAPPESO
7.3 Funzione riproduttiva
Diversi studi hanno dimostrato la completa reversibilità della soppressione dell’asse ipotalamo-ipofisi-gonadi dopo la sospensione del trattamento con analoghi del GnRH [9, 77, 110, 130] con ripresa dello sviluppo puberale e
110
comparsa del menarca nelle bambine trattate mediamente dopo 16 mesi dall’ultima somministrazione del farmaco [59].
Analogamente diversi studi hanno dimostrato come i livelli di testosterone risultino nei regolari range per l’età adulta [103] e la spermatogenesi non risulti compromessa dopo il trattamento con GnRHa, una volta che la funzionalità dell’asse ipotalamo-ipofisi-gonadi sia stata ripristinata dopo la soppressione ormonale [9].
I dati del presente studio confermano tali risultati: tutte le bambine trattate con GnRHa hanno avuto il menarca dopo la sospensione della terapia ad un’età media di 12.5 ± 0.74 anni , che rappresenta un valore adeguato per la media della popolazione normale in Italia [7]. L’intervallo di tempo decorso dall’interruzione del trattamento alla comparsa del menarca è stato mediamente di 0.9 ± 0.4 anni.
Nelle ragazze con un’età ginecologica almeno superiore a 6 mesi è stata riferita una ciclicità mestruale nell’ambito della norma.
Nella componente maschile del nostro campione di pazienti è stato riscontrato, mediante valutazione clinica del volume testicolare con orchidometro di Prader, il raggiungimento di un completo sviluppo gonadico nell’età adulta, con un volume testicolare medio di 19.2 ± 3.1 ml sia destra che a sinistra.
111
Tali risultati sembrano indicare che né la pubertà precoce né il suo trattamento influenzano in modo significativo la normale funzionalità dell’asse ipofisi-gonadi in età adulta.
112
8-CONCLUSIONI
In sintesi, i dati rilevati in questa tesi permettono di concludere che il trattamento con GnRH analoghi nei bambini con PPC è sicuro ed efficace. Esso:
determina in entrambi i sessi il raggiungimento di una statura adulta adeguata al potenziale genetico e nell’ambito della norma per la popolazione generale
garantisce risultati migliori sul guadagno staturale nei bambini che presentano minor età cronologica e maggior avanzamento dell’età ossea all’inizio della terapia
non presenta un impatto negativo sull’evoluzione del BMI nei pazienti affetti da PPC e non aumenta il rischio di obesità/sovrappeso nell’età adolescenziale ed adulta
non altera la normale attività dell’asse ipotalamo-ipofisi-gonadi alla sua sospensione.
113
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