Puberty and Its Disorders

Howard, Sasha; Roux, Nicolas; Léger, Juliane; Carel, Jean‐Claude; Dunkel, Leo

doi:10.1002/9781119152712.ch7

Cited by 15 publications

(9 citation statements)

References 85 publications

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“…The parents or caregiver were asked about the patient's pubertal status, distinguishing between “prepubertal” and “pubertal.” These estimations were used to test TBS differences between prepubertal and pubertal patients. ( 40 ) In order to avoid age bias, only subjects within the age ranges of the physiological onset of puberty (9 to 14 years in boys and 8 to 13 years in girls) ( 41 ) were included in this analysis.…”

Section: Methodsmentioning

confidence: 99%

Bone Microarchitecture Assessed by Trabecular Bone Score Is Independent of Mobility Level or Height in Pediatric Patients with Cerebral Palsy

Rehberg

Azim

Martakis

et al. 2020

Journal of Bone and Mineral Research

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Bone strength and fracture risk do not only depend on bone density, but also on bone structure. The trabecular bone score (TBS) evaluates homogeneity of bone microarchitecture indirectly by measuring gray‐level variations of two‐dimensional (2D) DXA images. Although TBS is well‐established for adults, there have been only few publications in pediatrics. In this monocentric retrospective analysis, we investigated TBS in children and adolescents with cerebral palsy (CP), a patient group vulnerable to low bone mineral mass due to impaired mobility. The influence of different parameters on TBS and areal BMD (aBMD) were evaluated, as well as the relationship between TBS and aBMD. We compared TBS values of our study population to a reference population. A total of 472 lumbar spine–dual‐energy X‐ray absorptiometry (LS‐DXA) scans of children and adolescents with CP (205 female), aged between 4 and 18 years, were analyzed. The DXA‐scans were part of the routine examination. The children had no records of fractures or specific bone diseases. Our study population with CP had similar TBS as the reference population. TBS did not increase with age until an inflection point at 10 years in females, and 12 years in males. Girls had significantly higher TBS than boys (p = .049) and pubertal girls aged 8 to 13 years had significantly higher TBS than prepubertal girls (p = .009). TBS standard deviation score for age (SDS‐TBS) and aBMD Z‐scores correlated weakly (p < .001; R = 0.276 [males], R = 0.284 [females]). Other than for aBMD Z‐scores, SDS‐TBS was not influenced by age‐adjusted height Z‐scores and there was no significant difference in SDS‐TBS when grouped by mobility levels, using the Gross Motor Function Classification System (GMFCS). Our results indicate that children with CP have a similar homogeneous distribution of trabecular microarchitecture as controls. Puberty initiation appears to be essential for increase of TBS with age and for sex differences. TBS seems less influenced by body composition, height, and mobility than aBMD. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

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Section: Methodsmentioning

confidence: 99%

Bone Microarchitecture Assessed by Trabecular Bone Score Is Independent of Mobility Level or Height in Pediatric Patients with Cerebral Palsy

Rehberg

Azim

Martakis

et al. 2020

Journal of Bone and Mineral Research

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“…Precocious puberty refers to the early onset of puberty in girls before the age of 8 years, while early puberty is characterized by puberty onset between the ages of eight and nine ( 1 , 2 ). Children with central precocious puberty (CPP) experience the onset of puberty at an early age due to the premature activation of the hypothalamic-pituitary-gonadal (HPG) axis.…”

Section: Introductionmentioning

confidence: 99%

“…The use of Gonadotropin-Releasing Hormone Analog (GnRHa) therapy is a well-established and commonly employed treatment approach in the management of CPP ( 3 ). GnRH analogue treatment is also started when puberty is accelerated in cases whose puberty symptoms begin after age 8 years ( 2 , 4 ). The prevalence of CNS abnormalities in girls is significantly lower compared to boys (16%-75%) ( 5 – 7 ), ranging from 0% to 27% across studies, and decreasing with age ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

MRI evaluation of cranial pathologies in rapidly progressive early puberty cases aged 8-9

Kılınç Uğurlu,

Özdemir Gökce,

Çakır Gündoğan

et al. 2024

Front. Endocrinol.

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PurposeThe aim of this study was to investigate the frequency and distribution of intracranial pathologies in female patients between 8 and 9 years of age who were diagnosed with early puberty (rapidly progressive) through the evaluation of MRI images.Materials and methodsA total of 74 female patients diagnosed with central precocious puberty (CPP) (6-8 years) and rapidly progressive early puberty (RPEP) (8-9 years) were included in the study. The patients were categorized into two groups, normal and abnormal, based on the findings from their MRI scans. Recent literature has classified abnormal MRI findings into three groups: pathological findings, findings with a questionable relationship to CPP, and incidental findings. Furthermore, the patients were divided into four groups based on their MRI findings and whether they had CPP or RPEP : CPP (6-8 years) +Normal MRI, RPEP (8-9 years) + Normal MRI, CPP (6-8 years) +Abnormal MRI, RPEP (8-9 years) +Abnormal MRI.ResultsOut of the 74 girls included in the study, 54% (n=40) showed normal MRI results, while abnormal MRI findings were detected in 46% (n = 34) of the cases. No malignant lesions were identified among cases with abnormal MRI findings. The occurrence of abnormal MRI findings was observed in 46% of the PP group and 45% of the RPEP group. Incidental findings were the most common MRI findings in both groups. The proportion of cases with pathological findings and findings with a questionable relationship to CPP was similar in both groups (p = 0.06). Basal luteinizing hormone (LH) concentration was found to be higher in the RPEP (8-9 years) +Abnormal MRI group compared to the CPP (6-8 years) +Normal MRI group (p = 0.01).ConclusionOur study is the first to investigate MRI findings in cases of rapidly progressive early puberty in the age range of 8–9 years. Our study demonstrates that there is no difference in terms of intracranial findings between cases of precocious puberty at the age of 6–8 years and cases of rapidly progressive early puberty aged 8-9.

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“…Therefore, identifying girls with central precocious puberty from those who do not is important. The gold standard for diagnosing CPP is an evaluation of the hypothalamicpituitary-gonadal axis maturation through the gonadotropin-releasing hormone (GnRH) stimulation test [3,5]. After GnRH injection, blood sampling is performed three to five times at different time points to measure serum gonadotropin concentration changes.…”

Section: Introductionmentioning

confidence: 99%

Machine Learning Approach for Prediction of the Test Results of Gonadotropin-Releasing Hormone Stimulation: Model Building and Implementation

et al. 2023

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Precocious puberty in girls is defined as the onset of pubertal changes before 8 years of age, and gonadotropin-releasing hormone (GnRH) agonist treatment is available for central precocious puberty (CPP). The gold standard for diagnosing CPP is the GnRH stimulation test. However, the GnRH stimulation test is time-consuming, costly, and requires repeated blood sampling. We aimed to develop an artificial intelligence (AI) prediction model to assist pediatric endocrinologists in decision making regarding the optimal timing to perform the GnRH stimulation test. We reviewed the medical charts of 161 girls who received the GnRH stimulation test from 1 August 2010 to 31 August 2021, and we selected 15 clinically relevant features for machine learning modeling. We chose the models with the highest area under the receiver operating characteristic curve (AUC) to integrate into our computerized physician order entry (CPOE) system. The AUC values for the CPP diagnosis prediction model (LH ≥ 5 IU/L) were 0.884 with logistic regression, 0.912 with random forest, 0.942 with LightGBM, and 0.942 with XGBoost. For the Taiwan National Health Insurance treatment coverage prediction model (LH ≥ 10 IU/L), the AUC values were 0.909, 0.941, 0.934, and 0.881, respectively. In conclusion, our AI predictive system can assist pediatric endocrinologists when they are deciding whether a girl with suspected CPP should receive a GnRH stimulation test. With proper use, this prediction model may possibly avoid unnecessary invasive blood sampling for GnRH stimulation tests.

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Puberty and Its Disorders

Cited by 15 publications

References 85 publications

Bone Microarchitecture Assessed by Trabecular Bone Score Is Independent of Mobility Level or Height in Pediatric Patients with Cerebral Palsy

Bone Microarchitecture Assessed by Trabecular Bone Score Is Independent of Mobility Level or Height in Pediatric Patients with Cerebral Palsy

MRI evaluation of cranial pathologies in rapidly progressive early puberty cases aged 8-9

Machine Learning Approach for Prediction of the Test Results of Gonadotropin-Releasing Hormone Stimulation: Model Building and Implementation

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