Diagnosing children with signs of early puberty: knowing when to test and when to just monitor

Kaplowitz, Paul B.

doi:10.1080/17446651.2016.1191350

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…Overall, many relatively healthy children or children with problems that do not have clinical-pathological significance (e.g., premature isolated thelarche/pubarche, gynecomastia), that can be initially managed in a primary setting (i.e., overweight/obesity, subclinical hypothyroidism) were sent for specialist examination. For example, premature isolated thelarche or subclinical hypothyroidism could be easily monitored by FP, without the need for specialist consultation, unless relevant symptoms and clinical signs appear, therefore requiring expert consultation and appropriate treatment ( 26 , 27 ). However, sometimes the difference between subclinical or para-physiological conditions and pathological ones may not be clear to a FP, therefore referral may be justified.…”

Section: Discussionmentioning

confidence: 99%

Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy

et al. 2020

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Introduction: The knowledge of the pattern and the features of pediatric endocrinology referrals is crucial to optimize resources and guide public health interventions. We explored the numbers and the reasons for referral to a pediatric endocrinology outpatient clinic and investigated their features in terms of assignment of priority ranks, sex, age differences, the prevalence of pathological findings among referred cases, and the agreement among referrals, final diagnosis, treatment, and follow-up. Methods: Retrospective study with data collection for pediatric endocrinology first visits between November 2012 and February 2019 in a tertiary center. Results: A total of 1930 first visits were performed with an overall number of referrals of 2,165, and an increasing trend over the years. The most frequent referral reasons were slow growth, precocious puberty, and obesity; 14% of visits were classified as “urgent” (<7 days), 35% as “deferrable” (<30 days), and 51% as “planned” (<180 days). Sex and age differences among referrals were detected, with criticality in the appropriate timing for referral. Thirty-eight percent of patients had pathological findings. In 4% of the cases the final diagnosis was not concordant with the reason for referral. Treatment was prescribed in 35% of cases, and 67% returned at least for one follow-up visit. Conclusion: The study highlighted the need to target medical education of primary care on the definition of priority ranks, the need for more extended observation periods for subclinical or para-physiological conditions, the appropriate timing for referral, based on the definition of conditions or the best window of intervention.

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Section: Discussionmentioning

confidence: 99%

Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy

et al. 2020

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“…The resumption of adrenal androgen synthesis from the zona reticularis at about 3 years of age roughly coincides with the age of weaning in natural fertility populations and the timing of clinically premature adrenarche. 115 "Biochemical adrenarche" coincides with the transition to middle childhood 116 and the cognitive and emotional changes associated with greater independence and responsibility that have been characterized as the "five-to-sevenyear shift." 117 Thus, biochemical adrenarche is a hormonal correlate, and possibly a contributing cause, of these behavioral changes, with clinical adrenarche serving as a phenotypic marker of these changes.…”

Section: Box 2 Adrenarchementioning

confidence: 99%

The tempo of human childhood: a maternal foot on the accelerator, a paternal foot on the brake

Kotler¹,

Haig

2018

Evolutionary Anthropology

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Relative to the life history of other great apes, that of humans is characterized by early weaning and short interbirth intervals (IBIs). We propose that in modern humans, birth until adrenarche, or the rise in adrenal androgens, developmentally corresponds to the period from birth until weaning in great apes and ancestral hominins. According to this hypothesis, humans achieved short IBIs by subdividing ancestral infancy into a nurseling phase, during which offspring fed at the breast, and a weanling phase, during which offspring fed specially prepared foods. Imprinted genes influence the timing of human weaning and adrenarche, with paternally expressed genes promoting delays in childhood maturation and maternally expressed genes promoting accelerated maturation. These observations suggest that the tempo of human development has been shaped by consequences for the fitness of kin, with faster development increasing maternal fitness at a cost to child fitness. The effects of imprinted genes suggest that the duration of the juvenile period (adrenarche until puberty) has also been shaped by evolutionary conflicts within the family.

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“…In older children, PP is most often a manifestation of the maturation of the zona reticularis of the adrenal gland, known as premature adrenarche [ 1 , 21 ]. In infants, however, it appears to be more complex.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, there are opinions that isolated pubic hair in infancy is a mild disorder and, under certain conditions, follow-up without intensive diagnosis is sufficient [ 6 , 8 , 21 , 28 ]. According to others, hair limited only to the scrotum is a mild variant of precocious puberty, but the occurrence of hair in the area of the perineal skin indicates the need for a broad diagnosis and search for the cause, e.g.…”

Section: Discussionmentioning

confidence: 99%

Premature pubarche during minipuberty – literature review and two case reports

Rakuś-Kwiatosz¹,

Budzyńska²,

Ben-Skowronek³

2023

pedm

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Introduction Isolated premature pubarche (PP) in infancy may be the reason for many diagnostic difficulties. This is due to the low incidence and, therefore, the limited number of studies on this subject and the lack of strict laboratory standards because of the physiological variability of gonadotropic hormone and androgen concentrations during minipuberty. Material and methods We aimed to present current knowledge about PP in infancy based on the literature review and 2 cases of male infants with scrotal hair during minipuberty. Results Isolated hair in the pubic region in a boy during the period of minipuberty requires differential diagnosis. After excluding serious aetiology, it seems to be a mild, self-limiting variant of precocious puberty. The phenomenon is probably a result of increased sensitivity of the hair follicles to transiently increased androgen concentration. Conclusions Isolated pubic hair in infancy as a mild, self-limiting variant of precocious puberty in infants should be a diagnosis of exclusion. The condition resolves spontaneously, but it absolutely requires further follow-up to exclude serious aetiology in the case of puberty progression.

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Diagnosing children with signs of early puberty: knowing when to test and when to just monitor

Cited by 4 publications

References 13 publications

Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy

Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy

The tempo of human childhood: a maternal foot on the accelerator, a paternal foot on the brake

Premature pubarche during minipuberty – literature review and two case reports

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