Has the Frequency of Precocious Puberty and Rapidly Progressive Early Puberty Increased in Girls During the COVID-19 Pandemic?

Abstract

Objective: Early puberty is development of secondary sex characteristics earlier than the expected normal age range. We subjectively observed an increased frequency of early puberty during the Coronavirus disease-2019 (COVID-19) lockdown and aimed to show the clinical, demographic characteristics of the cases and the change in its incidence. Methods: Female patients with central precocious puberty (CPP, n=28) and rapidly progressive early puberty (RPEP, n=61), presenting to our clinic before (January 2019-March 2020) and during the COVID-19 pandemic (April 2020-June 2021) were included. Results: Among 28 CPP cases, six (21%) presented before the pandemic lockdown, whereas 22 (79%) were diagnosed during the COVID-19 pandemic lockdown. While RPEP was seen in 16 (26%) patients before the pandemic, 45 (74%) patients were diagnosed during the lockdown period. Presentation with menarche was seen in 15 RPEP patients; two (13%) were in the prepandemic period and 13 (87%) were in the lockdown period. Chronological age, bone age, bone age to chronological age ratio, height, weight, and body mass index standard deviation scores of patients with RPEP and CPP were similar between the prepandemic and pandemic period. Conclusion: In this cohort, the frequency of CPP and RPP cases were significantly (p<0.001) increased during the COVID-19 pandemic, possibly due to environmental changes.

Analysis of the incidence of central precocious puberty treated with gonadotropin-releasing hormone analogs. Impact of the COVID-19 pandemic

“…This limitation itself makes it difficult for us to assess, in some cases, the rate of pubertal progression during the pandemic, in contrast to other authors who suggest an increased rate. 12,18,21 In conclusion, during the last 5 years, we have evidenced an increase in the incidence of ICPP, which seems to have accelerated during the COVID-19 pandemic. The increased exposure to environmental triggers during this period may have had a greater influence in girls with certain genetic predisposition.…”

“…In addition to the initial report, studies have been recently published in Spain, 17 Turkey, 18,19 China, 20 and Brazil, 21 which described similar accelerations in pubertal development and an increase in the incidence of ICPP. Changes in nutrition, body composition, and exposure to endocrine disruptors at home could have triggered hormonal changes amplified by the lockdown.…”

Análisis de la incidencia de pubertad precoz central tratada con análogos de hormona liberadora de gonadotrofina. Impacto de la pandemia por COVID-19

“…A partir de los datos recolectados en cinco centros italianos, 16 se constató que entre 2019 y 2020 hubo un aumento del 122 % en el número de casos derivados por cambios puberales tempranos y también en el de pubertad precoz confirmada; se destaca el incremento ocurrido durante el segundo semestre de 2020. Al reporte inicial, se sumaron recientes publicaciones de trabajos realizados en España, 17 Turquía, 18,19 China 20 y Brasil, 21 que describieron similares aceleraciones del desarrollo puberal y aumento de incidencia de PPCI.…”

“…Esta misma limitación nos dificulta, en algunos casos, la evaluación del ritmo de progreso de la pubertad durante la pandemia en contraposición a otros autores que sugieren aumento de este ritmo. 12,18,21 En conclusión, durante el último lustro hemos evidenciado aumento de incidencia de PPCI, que pareciera haberse acelerado durante la pandemia por COVID-19. El incremento en la exposición a desencadenantes ambientales durante este período podría haber ejercido mayor influencia en niñas con alguna predisposición genética.…”

COVID‐19 and early puberty—An unintended consequence of COVID‐19 lockdown?

“…As a plethora of factors contributes to the onset of puberty, even small adjustments in habits and daily routines can have a considerable impact on sexual development. One study in Turkey found that the COVID-19 pandemic resulted in increased frequency in the prevalence of CPP, in which 22 out of 28 (79%) female patients were diagnosed with post-COVID-19 lockdown CPP as compared to 6 out of 28 (21%) recorded before lockdown, and 45 out of 61 (74%) patients were diagnosed with rapidly progressive puberty (RPP) following COVID-19 lockdown as opposed to 16 out of 61 (26%) as recorded in the prelockdown period, most likely as a result of environmental changes (Acinikli et al, 2022). In tandem with our findings, another retrospec-tive analysis at a pediatric endocrinology center in India demonstrated an increase in precocious puberty referrals with 155 of 3053 diagnosed cases following the pandemic as opposed to 59 of 4208 diagnosed cases before the lockdown, along with a significant increase in the number of children identified with idiopathic CPP (iCPP) during the COVID lockdowns (Mondkar et al, 2022).…”