Implicating factors in the increase in cases of central precocious puberty (CPP) during the COVID-19 pandemic: Experience of a tertiary centre of pediatric endocrinology and review of the literature

Abstract

Sexual development is a complex mechanism activated by the hypothalamic-pituitary-gonadal axis. Over the last one hundred years there has been a decline in the age at puberty onset in industrialised countries. Some Italian studies showed an increase in diagnoses of Central Precocious Puberty (CPP) during the COVID-19 pandemic. It is thus supposed that in this period there was an increased impact of factors that can influence pubertal development. Our retrospective monocentric study aimed to confirm the existence of this phenomenon and analysed possible related factors. We retrospectively evaluated clinical, laboratory, radiological and ultrasound (US) data of 154 girls referred to our Tertiary Centre of Paediatric Endocrinology from January 2019 to April 2021 for different forms of Precocious Puberty. We subdivided the cases into subgroups according to the final diagnosis: CPP, Early Puberty (EP), isolated thelarche and isolated pubarche. The observation period was subdivided into: Period 1, before lockdown (1 January 2019 – 8 March 2020) and Period 2, lockdown and the following months (9 March 2020 – 30 April 2021). Period 2 was further divided into “restrictive lockdown period” (Period 2.1) (March 2020 – 14 June 2020, in which the schools were closed) and “less restrictive lockdown period” (Period 2.2) (15 June 2020 – 30 April 2021). We analysed data regarding the use of electronic devices before and during lockdown in a group of girls with CPP diagnosed in Period 2 and we compared the data with that of a control group. Our data show an increase in the number of new diagnoses of CPP during lockdown and in the following months, compared with the previous period. We also detected a higher use of PCs and smartphones in girls with CPP diagnosed in Period 2, compared with the control group. The percentage of the presence of endometrial rhyme detected during the pelvic ultrasound was higher in girls with CPP in Period 2, compared with the previous period. Based on our data we assume there was an environmental effect on pubertal timing that calls our attention to factors such as food, use of electronic devices and stress. We will need further studies to better understand this data.

COVID-19 pandemic phases and female precocious puberty: The experience of the past 4 years (2019 through 2022) in an Italian tertiary center

“…Recently, several centers of pediatric endocrinology worldwide, including ours, have observed a further significant increase in the number of girls presenting with precocious or early puberty since mid-2020 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). During this period, corresponding to the first wave of COVID-19 pandemic, the Italian government imposed a strict lockdown across the country, in order to reduce the transmission rate and to avoid hospital bed saturation.…”

Time trends towards earlier puberty in boys and girls with type 1 diabetes: Insights from the German Diabetes Prospective Follow‐up (DPV) registry, 2000 to 2021

“…This is in accordance with our finding that the normal weight and underweight patients with diabetes showed a similar secular trend to that in the overweight patients. The "gold standard" for the biochemi- Several studies 35,36 have recently reported that central precocious puberty occurred about three times more frequently during the COVID-19 pandemic in various countries. In particular, psychosocial stress during the lockdowns and changed lifestyle have been associated with this observation.…”

“…Several studies 35,36 have recently reported that central precocious puberty occurred about three times more frequently during the COVID‐19 pandemic in various countries. In particular, psychosocial stress during the lockdowns and changed lifestyle have been associated with this observation 37 .…”

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

“…Over 100 countries imposed variable lockdown measures either at local or national level following COVID-19, depending on the extent of spread of infection. Many countries imposed restrictions on flights from China, movement, and social contact, as well as visitors from high-risk areas were required to be quarantined (Coronavirus, 2020).Individuals, particularly children, were highly likely to spend more time at home due to the lockdown mandated by the governments of several countries, including Pakistan, Brazil, India, Turkey and China affecting their daily routine significantly (Ali et al, 2022;Barberi et al, 2022;Prosperi & Chiarelli, 2022). Lifestyle changes, such as dietary habits and sleep schedules, can have a substantial impact on a child's sexual development, including the initiation of puberty (Li et al, 2022).…”

“…Individuals, particularly children, were highly likely to spend more time at home due to the lockdown mandated by the governments of several countries, including Pakistan, Brazil, India, Turkey and China affecting their daily routine significantly (Ali et al, 2022;Barberi et al, 2022;Prosperi & Chiarelli, 2022). Lifestyle changes, such as dietary habits and sleep schedules, can have a substantial impact on a child's sexual development, including the initiation of puberty (Li et al, 2022).…”