Presentation of 493 Consecutive Girls with Idiopathic Central Precocious Puberty: A Single-Center Study

Abstract

BackgroundDespite the number of reported data concerning idiopathic central precocious puberty (CPP) in girls, major questions remain including its diagnosis, factors, and indications of gonadotropin releasing hormone (GnRH) analog treatment.MethodsA retrospective, single-center study was carried out on 493 girls with CPP.ResultsEleven girls (2.2%) were aged less than 3 years. Breast development was either isolated (Group 0, n = 99), or associated with one sign, pubic hair development, growth rate greater than 2 standard deviation score (SDS) or bone age (BA) >2 years above chronological age, (Group 1, n = 187), two signs (Group 2, n = 142) or three signs (Group 3, n = 65). The interval between onset of puberty and evaluation, body mass index (BMI) SDS, plasma luteinising hormone (LH) concentrations (basal and peak) and LH/ follicle-stimulating hormone (FSH) peak ratio after GnRH test, plasma estradiol and uterus length were significantly greater in Groups 2 and 3 than in Groups 0 and 1 respectively. 211 (42.8%) patients were obese and/or had excessive weight gain during the year before puberty. Obese girls more often had BA advance of >2 years (p = 0.0004) and pubic hair development (p = 0.003) than the others. BMI did not correlate with LH or with LH/FSH peak ratio. Girls with familial history of early puberty (41.4%) had greater frequencies of pubertal LH/FSH peak ratios (p = 0.02) than the others. During the 31 years of the study, there was no increase in the frequency of CPP or variation in its characteristics.ConclusionObesity is associated with a higher BA advance and higher frequency of pubic or axillary hair development but not with LH secretion, suggesting that obesity accelerates adrenarche but not the maturation of the hypothalamic-pituitary-ovarian axis. The LH/FSH peak ratio was more frequently pubertal in girls with a familial history of early puberty, suggesting that this maturation depends on genetic factors.

Assessment of normal, normal variants and precocious puberty in children referred with signs of early pubertal development to pediatric endocrine unit

“…Our higher rate can be explained by genetic and environmental factors. The mean age at the diagnosis was 7.5 years in precocious puberty consistent with the literature [32] .…”

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

“…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). 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 CPP cases, advanced bone age, increased growth rate and body weight are significant findings which are expected because of the effects of the sex hormones. Studies have found that 25-27% of the CPP patients are obese at the time of diagnosis (17,18) and 42,8% become obese in the last one year (18). Kılıç et al (19) found the bone age, height SDS, weight SDS, BMI and BMI-SDS values to be significantly higher in CPP patients compared to the PT group.…”

Puberdade precoce: condições associadas

“…Já os casos independentes de gonadotrofina são denominados de pseudopuberdade precoce, sendo resultantes da produção autônoma dos esteroides sexuais (2) . Tendo em vista que 95% das crianças do sexo feminino com puberdade precoce central (PPC) apresentam etiologia idiopática (3) , vários fatores têm sido apontados como potencial de risco na evolução para PPC, os quais estão relacionados a interferências ambientais; distúrbios metabólicos, incluindo a obesidade; e condições familiares, no caso da adoção (4) . Embora haja uma tendência secular para o início da puberdade mais cedo, a obesidade tem um importante significado nesse processo, como mostram estudos recentes acerca do papel da adiposidade no desenvolvimento puberal mais precoce no sexo feminino (5) , sem desconsiderar outros fatores, como polimorfismo genético, nutrição, atividade física e interferências ambientais (6) .…”