Etiology and Age Incidence of Precocious Puberty in Girls: A Multicentric Study

Abstract

We review the etiology and age incidence of precocious puberty in 438 girls examined between 1988-1998; 428 (97.7%) had central precocious puberty (CPP), the remaining 10 (2.3%) gonadotropin-independent precocious puberty (GIPP) of ovarian origin. The majority of CPP girls (59.6%) were aged between 7-7.9 yr, 22.4% were 6 year olds, and only 18% were under 6 years old. Cranial CT and/or MRI performed in 304/428 girls, showed neurogenic abnormalities in 56/304 (18.4%) CPP girls; 30 (9.9%) were due to previously diagnosed intracranial abnormalities and the remaining 26 (8.5%) were detected at the diagnosis of CPP. The frequency of neurogenic CPP tended to be higher in girls under 4 years of age while the frequency of idiopathic CPP tended to be higher in girls aged between 7-7.9 years, but no statistically significant differences were found. Interestingly, some CNS anomalies either of tumoral or congenital origin were detected at presentation in 7% of the girls aged over 7 years. Other related or coincidental clinical anomalies, mainly due to genetic diseases, were observed in 22/304 (7.2%) patients. History of precocious maternal menarche was found in 12/304 (4%) girls. In conclusion, idiopathic CPP was observed in 74% of the girls in this study. Neurogenic anomalies or other coincidental or related clinical findings were observed in the remaining 26%. The increased frequency of idiopathic CPP in girls aged over 7 years may suggest an early, but otherwise normal onset of puberty in many of these girls as a consequence of the trend towards earlier maturation. Nonetheless, the finding of CNS anomalies also in the older patients, raises the question of whether these patients should undergo a complete diagnostic work-up.

The utility of basal serum LH in prediction of central precocious puberty in girls

“…Previous studies on biochemical evaluation of girls with precocious puberty and its variants are relatively small (8) or based on multicenter studies using different hormone assays (9). Our results, carried out in a larger cohort, confirmed Lee et al's (6) findings of high specificity of a single basal LH sample and its usefulness for establishing the diagnosis of CPP.…”

Clinical and laboratory findings in the differential diagnosis of central precocious puberty and premature thelarche

“…In our study, the age at the time of diagnosis (7.12±1.18 years) and the age at the time of onset of the complaints (6.46±1.17 years) were found to be close to the literature data in idiopathic CPP cases. Cicternino et al (20) reorted that 59.6% of the CPP patients were diagnosed between the ages of 7 and 8 years, whereas organic CPP patients were diagnosed earlier (<4 years) (20). When Giabicani et al (18) classified idiopathic CPP cases by age groups, it was found that the age at the time of diagnosis was <3 year in 2.2%, 2-6 years in …”

“…In girls, CPP is frequently idiopathic and the mean age at the time of diagnosis is higher in cases of idiopathic CPP compared to the cases with organic cause (20). In a large-scale study in which girls with a diagnosis of CPP were evaluated (493 female patients), the mean age at the time of onset of the complaints was found to be 6.68±1.35 years and the age at the time of diagnosis was found to be 7.55±1.44 years (18).…”

Pubertad precoz: no solo una cuestión de edad

“…En cuanto a su etiología demostrable, la PPC puede resultar del compromiso directo o indirecto de la región hipotalámica por lesiones tumorales intracraneales o alteraciones hormonales, como es el caso de las pubertades precoces periféricas que pueden activar la secreción pulsátil de GnRH (hiperplasia suprarrenal congénita, síndrome de Mc Cune Albright, hipotiroidismo primario descompensado, entre otros) (54) . El diagnóstico clínico, por lo general, se realiza en base a la aparición y progresión de los caracteres sexuales secundarios y la aceleración de la velocidad de crecimiento; y se confirma con la aceleración de la maduración ósea, el desarrollo de los órganos reproductivos y la activación de la secreción pulsátil de la GnRH que reactiva el eje HHG (55,56) ; por lo que la PPC también recibe la denominación de pubertad precoz dependiente de GnRH.…”