Central precocious puberty: a review of diagnosis, treatment, and outcomes

Zevin, Erika L; Eugster, Erica A

doi:10.1016/s2352-4642(23)00237-7

Cited by 21 publications

(2 citation statements)

References 104 publications

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“…The scientific community has widely acknowledged the undisputed auxological and psychological beneficial effects of early recognition and treatment of progressive precocious puberty among girls aged 6 years or younger. Conversely, patients for whom the onset of puberty is detected between 6 and 8 years deserve an individualized approach, and the prescription of GnRH analogues should be regarded as the output of an integrated evaluation of clinical, auxological, biochemical and radiological data ( 17 , 18 ).…”

Section: Discussionmentioning

confidence: 99%

Pelvic ultrasound and pubertal attainment in girls with sexual precocity: the pivotal role of uterine volume in predicting the timing of menarche

Cattoni,

Russo,

Capitoli

et al. 2024

Front. Endocrinol.

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IntroductionAmong girls assessed for pubertal precocity, pelvic ultrasound (pUS) may represent a pivotal tool to predict the time expected to elapse between sonographic assessment and the onset of menarche (TUS-M). Accordingly, the present analysis is meant to define the statistical relationship between sonographic parameters and TUS-M, in order to identify the most reliable predictor of the timing of menarche.MethodsRetrospective, multicenter analysis. Girls assessed for sexual precocity and showing sonographic and clinical findings consistent with pubertal onset upon referral were considered eligible. Patients treated with GnRH analogues were excluded and only those who had subsequently achieved complete and spontaneous pubertal attainment and for whom the exact date of menarche was available were included. Overall, we enrolled 184 girls from five tertiary care Italian Centers.ResultsThe time elapsed (months) between baseline endocrine assessment and spontaneous achievement of menarche showed a negative statistically significant correlation (p<0.0001) with LH (r:-0.61), FSH (r:-0.59), estradiol (r:-0.52) and stimulated LH values (r:-0.58). Among pUS parameters, ovarian volume (r:-0.17 left, -0.30 right) and uterine body-to-cervix ratio (r:-0.18) poorly correlated with TUS-M, while uterine diameters (r:-0.61 longitudinal, -0.64 anteroposterior) and volume (r:-0.70) achieved a highly statistical significance (p<0.0001). Uterine volume (UV) showed a negative logarithmic relationship with TUS-M and represented the most reliable predictor of the timing of menarche in uni- and multivariable analyses (p <0.001). ROC analyses identified the UV thresholds that best predict the onset of menarche within 18, 12 and 6 months, respectively: 3.76, 6.02 and 8.80 ml.ConclusionThe logarithm of UV shows the best statistical performance in predicting the timing of menarche in girls assessed for pubertal precocity. Accordingly, we developed a user-friendly online application that provides clinicians with an estimation of the months expected to elapse before menarche, based on the UV recorded upon pUS.

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Section: Discussionmentioning

confidence: 99%

Pelvic ultrasound and pubertal attainment in girls with sexual precocity: the pivotal role of uterine volume in predicting the timing of menarche

Cattoni,

Russo,

Capitoli

et al. 2024

Front. Endocrinol.

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“…Reports indicate that the global incidence of CPP is approximately 0.6%, with a significantly higher prevalence in girls than in boys, making it one of the common pediatric endocrine disorders. 2 Studies 3,4 have demonstrated that CPP had led to advanced bone age, impacting a child's skeletal growth and resulting in short stature in adulthood, along with potential psychological burdens such as low self-esteem, depression, and social withdrawal. Therefore, early diagnosis and treatment of CPP are essential.…”

Section: Introductionmentioning

confidence: 99%

Integrated multicomponent analysis based on ultra‐high‐performance liquid chromatography coupled with quadrupole‐Exactive Orbitrap mass spectrometry and network pharmacology to elucidate the effective constituents and potential mechanism of Zhibai Dihuang pill in treating childhood precocious puberty

Zhang,

Yang,

Wulu

et al. 2024

Rapid Comm Mass Spectrometry

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RationaleChildhood precocious puberty (CPP) is a common pediatric endocrine disorder with significant associated risks. Zhibai Dihuang pill (ZBDHP), a classic recipe of the Qing dynasty with its efficacy of nourishing yin and clearing heat, can downregulate the expression of ESR1 in the uterus and ovaries, thereby inhibiting CPP. However, as of now, the main active ingredients and pharmacological mechanisms of ZBDHP remain unclear.MethodsA comprehensive approach was proposed using ultra‐high‐performance liquid chromatography coupled with quadrupole‐Exactive Orbitrap mass spectrometry (UHPLC‐Q‐Exactive Orbitrap‐MS) and network pharmacology to explore the potentially active constituents of ZBDHP and reveal the underlying mechanisms against CPP. Molecular docking was used to verify the possible mechanisms.ResultsA total of 214 constituents derived were identified via UHPLC‐Q‐Exactive Orbitrap‐MS, and 12 of them were definitely characterized using reference standards. Subsequently, compounds tetrahydropalmatine, alisol C, 25‐anhydroalisol A 11‐acetate, hispidone, cavidine, alisol E, melianone, neogitogenin, denudatin B, and 16β‐hydroperoxyalisol B with related targets PIK3CA, HSD11B1, CYP19A1, AR, PTGS2, CDK2, NR3C1, MMP2, MMP1, and MAPK1 were regarded as key components and targets for ZBDHP treating CPP using the compound–target–pathway network. Besides, the results revealed that the pathways conduced obviously to therapeutic efficacy, including pathways in cancer, neuroactive ligand–receptor interaction, and cyclic adenosine monophosphate（cAMP） signaling pathways. Molecular docking indicated that PIK3CA, HSD11B1, and CYP19A1 exhibited high affinities to corresponding compounds. Overall, the study determined the multicomponent, multitarget, and multipathway mechanisms of ZBDHP against CPP.ConclusionsThis study provided a new method for exploring the chemical constituents and pharmacology mechanism of traditional Chinese medicine.

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Abdominal imaging in precocious puberty in girls: can imaging determine onset of puberty?

Smets,

Sofia,

Bruno

et al. 2024

Pediatr Radiol

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Precocious puberty in girls is defined by the appearance of secondary sex characteristics before the age of 8 years. Precocious puberty is either peripheral or central. In most cases, the cause of central precocious puberty is unknown. Rapidly progressive forms of central precocious puberty may benefit from puberty suppression to prevent compromised final height and psychosocial problems related to the physical changes. Idiopathic central precocious puberty in girls can be a challenging diagnosis. Clinical examination, evaluation of growth charts, bone age, and hormonal tests are part of the workup. The role of pelvic ultrasound to evaluate pubertal features of the internal genitalia in this context is controversial. In this paper, we have reviewed the literature to find the scientific bases for several proposed ultrasound parameters and cutoff values for the determination of onset of puberty in girls with suspected central precocious puberty. There are no reliable cutoffs for the measurements of uterus and ovaries for the diagnosis of central precocious puberty and there is overlap in the appearance of the organs in both prepubertal and pubertal girls. The interpretation of the findings on pelvic ultrasound must be done with caution and always in close communication with the referring clinicians. Graphical Abstract

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Central precocious puberty: a review of diagnosis, treatment, and outcomes

Cited by 21 publications

References 104 publications

Pelvic ultrasound and pubertal attainment in girls with sexual precocity: the pivotal role of uterine volume in predicting the timing of menarche

Pelvic ultrasound and pubertal attainment in girls with sexual precocity: the pivotal role of uterine volume in predicting the timing of menarche

Abdominal imaging in precocious puberty in girls: can imaging determine onset of puberty?

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