title: Cognitive, Emotional, and Psychosocial Functioning of Girls Treated with Pharmacological Puberty Blockage for Idiopathic Central Precocious Puberty.
abstract: Central precocious puberty (CPP) develops due to premature activation of the hypothalamic-pituitary-gonadal (HPG) axis, resulting in early pubertal changes and rapid bone maturation. CPP is associated with lower adult height and increased risk for development of psychological problems. Standard treatment of CPP is based on postponement of pubertal development by blockade of the HPG axis with gonadotropin releasing hormone analogs (GnRHa) leading to abolition of gonadal sex hormones synthesis. Whereas the hormonal and auxological effects of GnRHa are well-researched, there is a lack of knowledge whether GnRHa treatment influences psychological functioning of treated children, despite the fact that prevention of psychological problems is used as one of the main reasons for treatment initiation. In the present study we seek to address this issue by exploring differences in cognitive function, behavior, emotional reactivity, and psychosocial problems between GnRHa treated CPP girls and age-matched controls. Fifteen girls with idiopathic CPP; median age 10.4 years, treated with slow-release GnRHa (triptorelin acetate-Decapeptyl SR® 11.25) and 15 age-matched controls, were assessed with a comprehensive test battery consisting of paper and pencil tests, computerized tasks, behavioral paradigms, heart rate variability, and questionnaires filled in by the children's parents. Both groups showed very similar scores with regard to cognitive performance, behavioral and psychosocial problems. Compared to controls, treated girls displayed significantly higher emotional reactivity (p = 0.016; Cohen's d = 1.04) on one of the two emotional reactivity task conditions. Unexpectedly, the CPP group showed significantly lower resting heart rates than the controls (p = 0.004; Cohen's d = 1.03); lower heart rate was associated with longer treatment duration (r = -0.582, p = 0.037). The results suggest that GnRHa treated CPP girls do not differ in their cognitive or psychosocial functioning from age matched controls. However, they might process emotional stimuli differently. The unexpected finding of lower heart rate that was associated with longer duration of the treatment should be further explored by methods appropriate for assessment of cardiac health.
authors.affiliation: Division of Surgery and Clinical Neuroscience, Department of Medical Neurobiology, Oslo University HospitalOslo, Norway; Department of Physiotherapy, Oslo and Akershus University College of Applied SciencesOslo, Norway.
authors.forename: Slawomir
authors.initials: S
authors.lastname: Wojniusz
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium.
authors.forename: Nina
authors.initials: N
authors.lastname: Callens
authors.affiliation: Division of Surgery and Clinical Neuroscience, Department of Medical Neurobiology, Oslo University HospitalOslo, Norway; Section for Psychology, Lillehammer University CollegeLillehammer, Norway.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sütterlin
authors.affiliation: Division of Surgery and Clinical Neuroscience, Department of Medical Neurobiology, Oslo University HospitalOslo, Norway; Department of Psychology, University of OsloOslo, Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Andersson
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent UniversityGhent, Belgium; Division of Pediatric Endocrinology, Department of Pediatrics, Brussels University HospitalBrussels, Belgium.
authors.forename: Jean
authors.initials: J
authors.lastname: De Schepper
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Brussels University Hospital Brussels, Belgium.
authors.forename: Inge
authors.initials: I
authors.lastname: Gies
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Brussels University Hospital Brussels, Belgium.
authors.forename: Jesse
authors.initials: J
authors.lastname: Vanbesien
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium.
authors.forename: Kathleen
authors.initials: K
authors.lastname: De Waele
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium.
authors.forename: Sara
authors.initials: S
authors.lastname: Van Aken
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium.
authors.forename: Margarita
authors.initials: M
authors.lastname: Craen
authors.affiliation: Research Unit INSIDE, Institute for Health and Behavior, University of Luxembourg Luxembourg, Luxembourg.
authors.forename: Claus
authors.initials: C
authors.lastname: Vögele
authors.affiliation: Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital and Ghent University Ghent, Belgium.
authors.forename: Martine
authors.initials: M
authors.lastname: Cools
authors.affiliation: Division of Surgery and Clinical Neuroscience, Department of Medical Neurobiology, Oslo University Hospital Oslo, Norway.
authors.forename: Ira R
authors.initials: IR
authors.lastname: Haraldsen
keywords: central precocious puberty; cognitive function; emotion regulation; gonadotropin releasing hormone analog; heart rate variability; psychosocial function; puberty