“Impact of COVID-19 pandemic lockdown on early onset of puberty: experience of an Italian tertiary center”

Abstract

At the end of 2019, an emerging atypical pneumonia called COVID-19 (coronavirus disease 2019), caused by the novel coronavirus defined as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), was first reported. COVID-19 rapidly expanded leading to an epidemic in China, followed by a global pandemic during the year 2020. In few weeks Italy was assaulted by a severe health emergency, constraining the Italian government to put in place extraordinary restrictive measures, such as school closures and a strict lockdown extended to the entire country at the beginning of March 2020. Since the beginning of lockdown, the Endocrinology Unit of Bambino Gesù Children’s Hospital has recorded a rapid increase of the outpatient consultations for suspected precocious or early puberty. We have now retrospectively analyzed all the consultations recorded in the database of our outpatient clinic from March to September 2020, and compared them with the consultations recorded in the same database from March to September 2019. Our preliminary data suggest a significant increase of precocious puberty cases in girls during the first period of COVID-19 pandemic. Further investigations in larger cohorts of children are needed in order to correlate the observed increase of precocious puberty with specific pathogenic factors.

Precocious Puberty and Covid-19 Into Perspective: Potential Increased Frequency, Possible Causes, and a Potential Emergency to Be Addressed

“…Since mid 2020 several centers of pediatric endocrinology in Italy, including ours, have observed a significant increase in the number of female patients presenting with precocious puberty, precocious menarche, and rapidly progressing puberty. Until now these observations have been reported by the Meyer Hospital in Florence just after the lockdown (1), and very recently by the main pediatric hospital in Rome in a letter to the Editor (2). The first report observed an increase in the number of diagnoses and an acceleration in the progression of puberty, and hypothesized that this phenomenon was associated with the increased use of electronic devices and increased body mass index (BMI) subsequent to reduced physical activity and possibly increased eating.…”

“…Nutrition is a known driver of sexual maturation ( 18 ). In malnourished adopted children a significant weight increase is well known to trigger precocious puberty ( 19 – 21 ), however, although during the pandemic BMI has generally increased because of reduced physical activity often this increase is not so significant ( 1 , 2 ), and above all, none of these girls were malnourished before the pandemic. Therefore, it is unknown whether a modest increase in BMI alone could explain an increased frequency of cases of precocious puberty observed in clinics.…”

Reduction in Pediatric Growth Hormone Deficiency and Increase in Central Precocious Puberty Diagnoses During COVID 19 Pandemics

“…similarly, in the second study, a rise in referrals for suspected precocious puberty was recorded in 2020 (+ 108% consultations compared to 2019) [17]. These results seem to suggest a possible role of environmental factors on the early onset of puberty during COVID-19 pandemics.…”

The Impact of Stress on Health in Childhood and Adolescence in the Era of the COVID-19 Pandemic

“…Finally, a significant increase of cases of central precocious puberty and a faster pubertal progression in girls has been reported since the beginning of COVID-19 pandemic [ 36 , 37 ]. This might be related to multiple environmental triggers, including the increase in fat mass, the prolonged exposure to electronic devices, as well as the psychological stress itself [ 36 ], whose role in acceleration of puberty timing proposed in past studies [ 38 ] remains to be demonstrated.…”