1
|
Klein KO, Vargas Trujillo M, Dragnic S, Van Komen S, Li M, Lee PA. Timing of onset of menses after GnRH agonist treatment for central precocious puberty. J Pediatr Endocrinol Metab 2024; 37:451-461. [PMID: 38618862 DOI: 10.1515/jpem-2023-0543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/15/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES To understand possible predictors of the onset of menses after gonadotropin-releasing hormone agonist treatment cessation in girls with central precocious puberty (CPP). METHODS This exploratory post hoc analysis of a phase 3 and 4 trial of girls with CPP treated with once-monthly intramuscular leuprolide acetate examined onset of menses after treatment completion using a time-to-event analysis. Pretreatment and end-of-treatment chronologic age (CA), bone age (BA)/CA ratio, and Tanner breast stage; pretreatment menses status; and end-of-treatment BA and body mass index (BMI) were studied as potential factors influencing the onset of menses. RESULTS Median time to first menses after stopping treatment was 18.3 months among 35 girls (mean age at onset of treatment, 6.8 years) examined. Of 26 girls experiencing menses, 11 (42 %) menstruated at 16-21 months after stopping treatment. Most girls with pretreatment BA/CA≥1.4 started menstruating very close to 18 months after stopping treatment; those with less advanced BA/CA experienced menses at 9-18 months. End-of-treatment BA/CA≥1.2 was associated with a quicker onset of menses (14.5 vs. 18.5 months for BA/CA<1.2, p=0.006). End-of-treatment BA≥12 years predicted longer time to menses. No relationship with time to menses was observed for pretreatment menarche status, pretreatment or end-of-treatment Tanner breast stage (<3/≥3) or CA (<6/≥6 or ≤11/>11), or end-of-treatment BMI percentiles (<85.6/≥85.6 and <92.6/≥92.6). CONCLUSIONS Pretreatment menarche status or CA do not appear to predict onset of menses, but pre- and end-of-treatment BA/CA may be helpful in anticipating time to first menses after stopping treatment.
Collapse
Affiliation(s)
- Karen O Klein
- Rady Children's Hospital, San Diego, CA, USA
- Department of Pediatrics, University of California, San Diego, CA, USA
| | - Marcela Vargas Trujillo
- Rady Children's Hospital, San Diego, CA, USA
- Department of Pediatrics, University of California, San Diego, CA, USA
| | | | | | | | - Peter A Lee
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Penn State Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
2
|
Yue M, Zhang L. Exploring the Mechanistic Interplay between Gut Microbiota and Precocious Puberty: A Narrative Review. Microorganisms 2024; 12:323. [PMID: 38399733 PMCID: PMC10892899 DOI: 10.3390/microorganisms12020323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
The gut microbiota has been implicated in the context of sexual maturation during puberty, with discernible differences in its composition before and after this critical developmental stage. Notably, there has been a global rise in the prevalence of precocious puberty in recent years, particularly among girls, where approximately 90% of central precocious puberty cases lack a clearly identifiable cause. While a link between precocious puberty and the gut microbiota has been observed, the precise causality and underlying mechanisms remain elusive. This narrative review aims to systematically elucidate the potential mechanisms that underlie the intricate relationship between the gut microbiota and precocious puberty. Potential avenues of exploration include investigating the impact of the gut microbiota on endocrine function, particularly in the regulation of hormones, such as gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH). Additionally, this review will delve into the intricate interplay between the gut microbiome, metabolism, and obesity, considering the known association between obesity and precocious puberty. This review will also explore how the microbiome's involvement in nutrient metabolism could impact precocious puberty. Finally, attention is given to the microbiota's ability to produce neurotransmitters and neuroactive compounds, potentially influencing the central nervous system components involved in regulating puberty. By exploring these mechanisms, this narrative review seeks to identify unexplored targets and emerging directions in understanding the role of the gut microbiome in relation to precocious puberty. The ultimate goal is to provide valuable insights for the development of non-invasive diagnostic methods and innovative therapeutic strategies for precocious puberty in the future, such as specific probiotic therapy.
Collapse
Affiliation(s)
- Min Yue
- Microbiome-X, National Institute of Health Data Science of China & Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
| | - Lei Zhang
- Microbiome-X, National Institute of Health Data Science of China & Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao 266237, China
| |
Collapse
|
3
|
Buyukyilmaz G, Koca SB, Adiguzel KT, Gurbuz F, Boyraz M. Body mass index evolution and ovarian function in adolescent girls who received GnRH agonist treatment for central precocious puberty or early and fast puberty. J Pediatr Endocrinol Metab 2023; 36:1044-1051. [PMID: 37735929 DOI: 10.1515/jpem-2023-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES Gonadotropin-releasing hormone agonist (GnRHa) has been used for central precocious puberty (CPP) or early and fast puberty. It was aimed to assess changes in body mass index (BMI), polycystic ovary syndrome (PCOS) frequency, and anti-Müllerian hormone (AMH) in girls who had been treated with GnRHa. METHODS Fifty-eight adolescent girls treated with GnRHa for CPP or early and fast puberty (3.75 mg/28 days), between 2011 and 2015, were re-evaluated in 2020-2022 at least 2 years after menstruation. Hormonal analyses were compared with 51 healthy adolescents. RESULTS In the GnRHa-treated group, a statistically significant increase was observed when the BMI standard deviation score (SDS) at the beginning of the treatment was compared with the BMI SDS at the end of the treatment (p=0.038). A statistically significant decrease was observed when the BMI SDS at the end of the treatment was compared with the BMI SDS in late adolescence (p=0.012). When the BMI SDS at the beginning of the treatment was compared with the BMI SDS in late adolescence, it was observed that there was no statistically significant difference (p=0.196). Of the 58 girls in the GnRHa-treated group, 8 (14 %) had PCOS. Serum AMH levels did not differ between the GnRHa-treated and the control group. CONCLUSIONS GnRHa treatment causes no adverse effect on BMI, at least in late adolescence. Girls treated with GnRHa were not found to be prone to developing PCOS. AMH levels were similar in the GnRHa-treated group as in the control group.
Collapse
Affiliation(s)
- Gonul Buyukyilmaz
- Department of Pediatric Endocrinology, Ankara City Hospital, Ankara, Türkiye
| | - Serkan Bilge Koca
- Department of Pediatrics, Division of Pediatric Endocrinology, Health Sciences University, Kayseri City Hospital, Kayseri, Türkiye
| | | | - Fatih Gurbuz
- Department of Pediatric Endocrinology, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Türkiye
| | - Mehmet Boyraz
- Department of Pediatric Endocrinology, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Türkiye
| |
Collapse
|
4
|
Alghamdi A. Precocious Puberty: Types, Pathogenesis and Updated Management. Cureus 2023; 15:e47485. [PMID: 38021712 PMCID: PMC10663169 DOI: 10.7759/cureus.47485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Precocious puberty (PP) means the appearance of secondary sexual characters before the age of eight years in girls and nine years in boys. Puberty is indicated in girls by the enlargement of the breasts (thelarche) in girls and in boys by the enlargement of the testes in either volume or length (testicular volume = 4 mL, testicular length = 25 mm, or both). Two types of PP are recognized - namely central PP (CPP) and peripheral PP (PPP). This paper aims to describe the clinical findings and laboratory workup of PP and to illustrate the new trends in the management of precocious sexual maturation. Gonadotropin-releasing hormone (GnRH)-independent type (PPP) refers to the development of early pubertal maturation not related to the central activation of the hypothalamic-pituitary-gonadal (HPG) axis. It is classified into genetic or acquired disorders. The most common forms of congenital or genetic causes involve McCune-Albright syndrome (MAS), familial male-limited PP, and congenital adrenal hyperplasia. The acquired causes include exogenous exposure to androgens, functioning tumors or cysts, and the pseudo-PP of profound primary hypothyroidism. On the other hand, CPP is the most common and it is a gonadotropin-dependent form. It is due to premature maturation of the HPG axis. CPP may occur as genetic alterations, such as MKRN3, DLK1, or KISS1;as a part of mutations in the epigenetic factors that regulate the HPG axis, such as Lin28b and let-7; or as a part of syndromes, central lesions such as hypothalamic hamartoma, and others. A full, detailed history and physical examination should be taken. Furthermore, several investigations should be conducted for both types of PP, including the estimation of serum gonadotropins such as luteinizing and follicle-stimulating hormones and sex steroids, in addition to a radiographic workup and thyroid function tests. Treatment depends on the type of PP: Long-acting GnRHa, either intramuscularly or implanted, is the norm of care for CPP management, while in PPP, especially in congenital adrenal hyperplasia, the goal of management is to suppress adrenal androgen secretion by glucocorticoids. In addition, anastrozole and letrozole - third-generation aromatase inhibitors - are more potent for MAS.
Collapse
Affiliation(s)
- Ahmed Alghamdi
- Pediatric Endocrinology, Faculty of Medicine, Al Baha University, Al Baha, SAU
| |
Collapse
|
5
|
Bloomfield V, Iseyemi A, Kives S. Clinical Review: Prepubertal Bleeding. J Pediatr Adolesc Gynecol 2023; 36:435-441. [PMID: 37301426 DOI: 10.1016/j.jpag.2023.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/15/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Prepubertal bleeding is a common presentation in the pediatric office and can be distressing for patients and families. A comprehensive approach to diagnosis and management allows clinicians to identify patients at risk for worrisome pathology and arrange timely care. OBJECTIVE We aimed to review the key features of clinical history, physical exam, and diagnostic workup of a child presenting with prepubertal bleeding. We reviewed potential pathologies requiring urgent investigations and management, such as precocious puberty and malignancy, as well as more common etiologies, including foreign bodies and vulvovaginitis. CONCLUSION Clinicians should approach each patient with the goal of excluding diagnoses that require urgent interventions. A thoughtful clinical history and physical exam can inform appropriate investigations to optimize patient care.
Collapse
Affiliation(s)
- Valerie Bloomfield
- Department of Pediatric and Adolescent Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Abigail Iseyemi
- Department of Obstetrics and Gynecology, London Health Sciences Center - Victoria Hospital, London, Ontario, Canada
| | - Sari Kives
- Department of Pediatric and Adolescent Gynecology, Hospital for Sick Children, Toronto, Ontario, Canada.
| |
Collapse
|
6
|
Fisch-Shvalb N, Alfandary-Harani H, Lazar L, Davidovits M, Shvalb N, Demol-Eliaz S, Yackobovitch-Gavan M, de Vries L. Blood pressure in girls with central precocious puberty receiving GnRH analogue therapy. J Pediatr Endocrinol Metab 2023; 36:726-731. [PMID: 37392130 DOI: 10.1515/jpem-2023-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/16/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES Case reports show hypertension in children treated with GnRH analogues for central precocious puberty (CPP). However, relevant data on blood pressure are scarce. We aimed to evaluate blood pressure (BP) among girls with idiopathic CPP and early-onset puberty before and during GnRH analogue therapy; and to examine associations of blood pressure with clinical parameters. METHODS For this retrospective longitudinal cohort study, demographic, anthropometric, clinical, and laboratory data were collected from electronic files. The study group included 112 girls with idiopathic CPP or early-onset puberty followed in a tertiary pediatric endocrinology institute, and a control group of 37 healthy pre-pubertal girls. The main outcome measures were BP percentile, before, and during treatment with GnRH analogue. RESULTS At baseline, similar proportions of the study and control groups had BP values>90th percentile: 64 (53 %) and 17 (46 %), respectively (p=0.57). The mean systolic and diastolic BP percentiles measured under treatment remained unchanged. In the study group, baseline BP>90th percentile compared to normal baseline BP was associated with lower birthweight and a higher body mass index-standard deviation score: 2,821 ± 622 vs. 3,108 ± 485 g and 1.0 ± 0.7 vs. 0.70 ± 0.8, respectively, p=0.01 for both. CONCLUSIONS GnRH analogue therapy for precocious or early puberty was not associated with increased blood pressure. The stability of mean blood pressure percentile during treatment is reassuring.
Collapse
Affiliation(s)
- Naama Fisch-Shvalb
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Alfandary-Harani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Schneider Children's Medical Center of Israel, Institute of Nephrology, Petach Tikva, Israel
| | - Liora Lazar
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Nir Shvalb
- Faculty of Engineering, Ariel University, Ariel, Israel
| | - Sharon Demol-Eliaz
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Petach Tikva, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liat de Vries
- National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, The Jesse Z. and Lea Shafer Institute of Endocrinology and Diabetes, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Kardaş B, Kardaş Ö, Demiral M, Özbek MN. Early puberty paradox: an investigation of anxiety levels of mothers and children, children's quality of life, and psychiatric diagnoses. Eur J Pediatr 2023; 182:3775-3783. [PMID: 37335399 DOI: 10.1007/s00431-023-05057-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
Early puberty signs lead to an increase in anxiety levels of parents and children. The aim of this study was to investigate the quality of life and anxiety levels of girls and their mothers who were admitted to a pediatric endocrinology clinic with concerns about early puberty. Girls and their mothers who were admitted to endocrinology outpatient clinic with concerns about early puberty were compared to healthy control group. Screen for Child Anxiety Related Emotional Disorders (SCARED) parent form, Quality of Life for Children Scale (PedsQL) parent form, and Beck Anxiety Inventory (BAI) were administered to the mothers. Children were evaluated with the Schedule for Affective Disorders and Schizophrenia for School-Age Children (Kiddie-SADS Lifetime Version) (K-SADS-PL). The study sample consisted of 92 girls and 62 of them were administered to clinic with concerns about early puberty. There were 30 girls in early puberty group (group 1), 32 girls were in the normal development group (group 2), and 30 were in the healthy control group (group 3). The anxiety level of group 1 and group 2 was significantly higher, and their quality of life was significantly lower when compared to group 3 (p < 0.001). Mother's anxiety level was found significantly higher in group 2 (p < 0.001). It has shown that anxiety level and quality of life of children were associated with anxiety level of mothers and the current Tanner stage (r = 0.302, p < 0.005). Conclusion: Mothers and children who have concerns about early puberty are negatively affected when early puberty is a possibility. For this reason, educating parents will prevent negative impacts of this situation on children. At the same time, it will decrease health burden. What is Known? • Early adolescence is one of the most common reasons for admission to pediatric endocrinology outpatient clinics. It is known that increasing early adolescence anxiety in the society causes cost and time losses in the field of health. However, studies investigating the reasons for this result are limited in the literature. What's New? • The level of anxiety increased significantly in girls with suspected precocious puberty and their mothers, and their quality of life was affected. • For this reason, we would like to emphasize the importance of multidisciplinary approaches before psychiatric disorders occur in children with suspected precocious puberty and their parents.
Collapse
Affiliation(s)
- Burcu Kardaş
- School of Medicine, Child and Adolescent Psychiatry Department, Kocaeli University, Kocaeli, Turkey.
| | - Ömer Kardaş
- School of Medicine, Child and Adolescent Psychiatry Department, Kocaeli University, Kocaeli, Turkey
| | - Meliha Demiral
- Department of Pediatric Endocrinology, Balıkesir Atatürk City Hospital, Balıkesir, Turkey
| | - Mehmet Nuri Özbek
- Department of Pediatric Endokrinology, Mardin Artuklu University School of Medicine, Mardin, Turkey
| |
Collapse
|
8
|
Cheuiche AV, Moro C, Lucena IRS, de Paula LCP, Silveiro SP. Accuracy of doppler assessment of the uterine arteries for the diagnosis of pubertal onset in girls: a scoping review. Sci Rep 2023; 13:5791. [PMID: 37031290 PMCID: PMC10082829 DOI: 10.1038/s41598-023-32880-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/04/2023] [Indexed: 04/10/2023] Open
Abstract
The uterine artery pulsatility index (PI) assessed by Doppler ultrasound reflects the impedance to the blood flow in the vessel distal to the sampling point. We aimed to assess the accuracy of the uterine artery PI for the diagnosis of puberty in girls. A PRISMA-ScR-compliant scoping review was performed in the MEDLINE and Embase databases with the search terms "puberty" and "Doppler ultrasonography". Studies that included girls aged 0-18 years who underwent pelvic Doppler ultrasound with calculation of uterine artery PI were eligible. Ten studies comprising 1385 girls aged 1.2-18 years were included. The selected studies included participants from Italy, Brazil, Iran, Belgium and Denmark, and were published between 1996 and 2021. Six studies selected girls who were referred for evaluation of pubertal disorders, while four studies included only healthy girls. Nine studies found a significant difference in Doppler signal pattern and PI according to pubertal stage, with PI cutoff points ranging from 2.5 to 4.6 for the diagnosis of puberty, with a sensitivity of 77%-94%, specificity of 85%-100%, and accuracy of 79%-98%. Doppler assessment of the uterine arteries with PI calculation is a useful noninvasive tool in the diagnosis of pubertal onset in girls.
Collapse
Affiliation(s)
- Amanda Veiga Cheuiche
- Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Candice Moro
- Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Leila Cristina Pedroso de Paula
- Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sandra Pinho Silveiro
- Graduate Program in Medical Science: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
- Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| |
Collapse
|
9
|
Correlation between imaging findings and hormonal markers at the onset of puberty in girls. RADIOLOGIA 2023; 65:3-11. [PMID: 36842783 DOI: 10.1016/j.rxeng.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION This study aimed to determine the diagnostic performance of transabdominal pelvic ultrasonography and bone age in identifying the onset of puberty in girls at the Clínica Las Américas in Medellín, Colombia. METHODS We included girls aged ≤11 years referred to our clinic between March 2016 and March 2019 for signs of puberty. We compared the findings on pelvic and breast ultrasonography and bone age versus the baseline measurement of luteinizing hormone (LH) in serum, used as the reference standard for identifying the onset of puberty. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios, analyzing subgroups of patients of different ages. RESULTS We analyzed 43 patients. Ultrasound assessment of breast development had the highest sensitivity (94.1%) of all the imaging parameters evaluated, but its specificity was low. However, characteristics such as the length of the body of the uterus >3.0 cm and the presence of endometrial echoes were highly specific for identifying the onset of puberty, particularly in patients aged ≤8 years. CONCLUSION Pelvic ultrasonography, ultrasonographic assessment of Tanner stage of breast development, and the evaluation of bone age are useful tools for the imaging confirmation of the onset of puberty. The results of this study support the use of these techniques in clinical practice in the workup for pubertal disorders in girls.
Collapse
|
10
|
Gea M, Toso A, Bentivegna GN, Buganza R, Abrigo E, De Sanctis L, Schilirò T. Oestrogenic Activity in Girls with Signs of Precocious Puberty as Exposure Biomarker to Endocrine Disrupting Chemicals: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:14. [PMID: 36612336 PMCID: PMC9819927 DOI: 10.3390/ijerph20010014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
The relationship between endocrine disrupting chemical (EDC) exposure and Precocious Puberty (PP) was investigated in this pilot study, involving girls with signs of PP (P) and pre-pubertal girls (C). Risk factors for PP were assessed through questionnaires, while 17β-oestradiol (E2) levels and oestrogenic activity were quantified on sera. The oestrogenic activity, expressed as E2 equivalent concentration (EEQ), was applied as EDC exposure biomarker. Questionnaires showed a low EDC knowledge, a high EDC exposure, and a potential relationship between some habits at risk for EDC exposure and PP. EEQs were similar between C and P; however, they were significantly higher in girls living in an urban environment than in girls living in a rural environment, suggesting a potential higher EDC exposure in cities. The results of this pilot study highlighted the need to raise awareness on EDCs and can be considered a starting point to clarify the relationship between EDC exposure and PP.
Collapse
Affiliation(s)
- Marta Gea
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
| | - Anna Toso
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
- Institut de Recherche en Cancérologie de Montpellier (IRCM), Inserm U1194, Institut régional du Cancer de Montpellier (ICM), Université Montpellier, 34090 Montpellier, France
| | | | - Raffaele Buganza
- Unit of Pediatric Endocrinology, Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, 10126 Turin, Italy
| | - Enrica Abrigo
- Unit of Pediatric Endocrinology, Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, 10126 Turin, Italy
| | - Luisa De Sanctis
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
- Unit of Pediatric Endocrinology, Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, 10126 Turin, Italy
| | - Tiziana Schilirò
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy
| |
Collapse
|
11
|
Norelius R. Juvenile Benign Diseases of the Breast. Surg Clin North Am 2022; 102:1065-1075. [DOI: 10.1016/j.suc.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
12
|
Han XX, Zhao FY, Gu KR, Wang GP, Zhang J, Tao R, Yuan J, Gu J, Yu JQ. Development of precocious puberty in children: Surmised medicinal plant treatment. Biomed Pharmacother 2022; 156:113907. [DOI: 10.1016/j.biopha.2022.113907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022] Open
|
13
|
KILAVUZ S, BEZEN D, SÜT N, DİLEK E, TÜTÜNCÜLER F. Etiological, Clinical and Biochemical Characteristics of 367 Children with Early Pubertal Development from Thrace Region of Turkey. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1176227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Appearance of menarche before nine years of age, secondary sex characteristics before 8 in girls and 9 in boys is defined as Precocious Puberty (PP).
Objective: The aim of this study was to describe etiologies, clinical findings, and compare anthropometric properties and biochemical characteristics of children with PP.
Methods: In this single-centre study, 367 patients of whom medical records were reviewed diagnosed as premature thelarche (PT), premature adrenarche (PA), Central PP (CPP), and peripheral PP (PPP). The diagnosis was based on clinical, laboratory, and radiologic investigations and their follow-up.
Results: During six years, 349 girls (%95,1) and 18 boys (%4,9) diagnosed as PP. The most common etiologies were CPP;127 (%34,6), PT;117 (%31,9), PA;112(%30,5) and PPP 11(%3), respectively. CPP group had significantly higher levels of height, weight, body mass index (BMI) and obesity/overweight incidence, estradiol (E2), basal luteinizing hormone (LH), peak LH, and peak LH/ follicle-stimulating hormone (FSH) ratio and higher uterine dimensions compared to the PT group while the PT group had significantly higher levels of peak FSH compared to the CPP group (p
Collapse
Affiliation(s)
- Sebile KILAVUZ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Diğdem BEZEN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL OKMEYDANI SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Necdet SÜT
- TRAKYA ÜNİVERSİTESİ, TRAKYA ARAŞTIRMA VE UYGULAMA MERKEZİ
| | | | | |
Collapse
|
14
|
Osinubi AA, Lewis-de Los Angeles CP, Poitevien P, Topor LS. Are Black Girls Exhibiting Puberty Earlier? Examining Implications of Race-Based Guidelines. Pediatrics 2022; 150:188594. [PMID: 35909158 DOI: 10.1542/peds.2021-055595] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | - Patricia Poitevien
- Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Pediatrics
| | - Lisa Swartz Topor
- Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Department of Pediatrics.,Division of Pediatric Endocrinology, Hasbro Children's Hospital, Providence, Rhode Island
| |
Collapse
|
15
|
dos Santos NR, Rodrigues JLG, Bandeira MDJ, Anjos ALDS, Araújo CFDS, Adan LFF, Menezes-Filho JA. Manganese and Lead Exposure and Early Puberty Onset in Children Living near a Ferromanganese Alloy Plant. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7158. [PMID: 35742410 PMCID: PMC9222911 DOI: 10.3390/ijerph19127158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023]
Abstract
Manganese (Mn) and lead (Pb) have been associated with the deregulation of the neuroendocrine system, which could potentially favor the appearance of precocious puberty (PP) in environmentally exposed children. This study aims to evaluate the exposure to Mn and Pb and their potential effects in anticipating puberty in school-aged children living near a ferromanganese alloy plant in Bahia, Brazil. Toenail, occipital hair and blood samples were collected from 225 school-aged children. Tanner’s scale was used for pubertal staging. Mn in blood (MnB), toenail (MnTn) and hair (MnH) and blood lead (PbB) levels were measured by graphite furnace atomic absorption spectrometry. Puberty-related hormone concentrations were determined by chemiluminescence. The age at which girls’ breasts began to develop was inversely correlated with weight-for-age, height-for-age and BMI-for-age Z-scores (p < 0.05); pubarche also had similar results. Mn biomarker levels did not present differences among pubertal classification nor among children with potential PP or not. Furthermore, Mn exposure was not associated with the age of onset of sexual characteristics for either girls or boys. However, PbB levels were positively correlated with boys’ pubic hair stages (rho = 0.258; p = 0.009) and associated with the age of onset of girls’ pubarche (β = 0.299, 95%CI = 0.055−0.542; p = 0.017). Testosterone and LH concentrations were statistically higher in boys with an increased PbB (p = 0.09 and p = 0.02, respectively). Prospective studies are needed to better assess the association between exposure to Mn and Pb and the early onset of puberty.
Collapse
Affiliation(s)
- Nathália Ribeiro dos Santos
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (N.R.d.S.); (A.L.d.S.A.)
- Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (J.L.G.R.); (M.d.J.B.)
| | - Juliana Lima Gomes Rodrigues
- Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (J.L.G.R.); (M.d.J.B.)
| | - Matheus de Jesus Bandeira
- Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (J.L.G.R.); (M.d.J.B.)
| | - Ana Laura dos Santos Anjos
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (N.R.d.S.); (A.L.d.S.A.)
| | - Cecília Freitas da Silva Araújo
- Environmental and Public Health Program, National School of Public Health, Oswald Cruz Foundation, Rio de Janeiro 21041-210, Brazil;
| | - Luis Fernando Fernandes Adan
- Graduate Program in Medicine and Health, College of Medicine, Federal University of Bahia, Salvador 40170-110, Brazil;
| | - José Antonio Menezes-Filho
- Laboratory of Toxicology, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (N.R.d.S.); (A.L.d.S.A.)
- Graduate Program in Pharmacy, College of Pharmacy, Federal University of Bahia, Salvador 40170-110, Brazil; (J.L.G.R.); (M.d.J.B.)
| |
Collapse
|
16
|
de Oliveira Neto CP, Azulay RSDS, de Almeida AGFP, Tavares MDGR, Vaz LHG, Leal IRL, Gama MEA, Ribeiro MRC, Nascimento GC, Magalhães M, dos Santos WC, Facundo AN, Faria MDS, Lago DCF. Differences in Puberty of Girls before and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4733. [PMID: 35457600 PMCID: PMC9031193 DOI: 10.3390/ijerph19084733] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 11/25/2022]
Abstract
In the COVID-19 pandemic, there was an increase in consultations for precocious puberty. We aim to analyze differences in female puberty before and during the COVID-19 pandemic. A cross-sectional analytical study was designed at the Pediatric Endocrinology Clinic of the University Hospital of the Federal University of Maranhão in São Luis, Brazil. We included 55 girls with precocious puberty, 22 who started puberty during the pandemic and 33 who started puberty before the pandemic. Clinical, anthropometric, laboratory and imaging variables were compared between groups. Statistics were performed to determine if there was a statistical difference between the groups. Girls with puberty during the pandemic had higher Z-scores for weight (1.08 ± 1.29 versus 0.69 ± 0.83; p = 0.04), lower ovarian volume (1.88 ± 0.95 versus 3.15 ± 2.31; p = 0.01), and smaller differences between thelarche noticed by the parents and the diagnosis (6.63 ± 5.21 versus 12.15 ± 9.96; p = 0.02). The association between precocious puberty during the pandemic with higher Z-scores for weight, lower ovarian volume, and a reduction in the time between the perception of pubertal findings by parents and the diagnosis suggests the influence of the pandemic on the normal time of puberty.
Collapse
Affiliation(s)
- Clariano Pires de Oliveira Neto
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Postgraduate Program in Health Sciences, Federal University of Maranhão, São Luis 65080-805, Brazil
| | - Rossana Santiago de Sousa Azulay
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
| | - Ana Gregória Ferreira Pereira de Almeida
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
| | - Maria da Glória Rodrigues Tavares
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
| | - Luciana Helena Gama Vaz
- Service of Pediatric Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (L.H.G.V.); (I.R.L.L.)
| | - Ianik Rafaela Lima Leal
- Service of Pediatric Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (L.H.G.V.); (I.R.L.L.)
| | - Monica Elinor Alves Gama
- Department of Medicine III, Federal University of Maranhão, São Luis 65020-240, Brazil; (M.E.A.G.); (M.R.C.R.)
| | | | - Gilvan Cortês Nascimento
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
| | - Marcelo Magalhães
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Clinical Research Center, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil
| | - Wellyandra Costa dos Santos
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Clinical Research Center, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil
| | - Alexandre Nogueira Facundo
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
| | - Manuel dos Santos Faria
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Postgraduate Program in Health Sciences, Federal University of Maranhão, São Luis 65080-805, Brazil
- Clinical Research Center, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil
| | - Débora Cristina Ferreira Lago
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Service of Pediatric Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (L.H.G.V.); (I.R.L.L.)
| |
Collapse
|
17
|
de Souza KBF, Veiga MSP, Martins GRF, da Silva AP, Fujita LGA, Tomé JM, Palhares HMDC, Borges MDF. Assessment of Gonadotropin Concentrations Stimulated by Gonadotropin-Releasing Hormone Analog by Electrochemiluminescence in Girls with Precocious Puberty and Premature Thelarche. Horm Res Paediatr 2022; 94:433-440. [PMID: 34933304 DOI: 10.1159/000521593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to determine the cutoff values of gonadotropin response to gonadotropin-releasing hormone analogs (GnRHas) corresponding to the activation of the hypothalamic-pituitary-gonadal axis that could differentiate central precocious puberty (CPP) from premature thelarche (PT) and using the electrochemiluminescence assay method. METHODS A total of 49 girls underwent the stimulation test with an intramuscular injection of 3.75 mg leuprolide acetate. Based on the clinical and laboratory characteristics, they were divided into two groups: CPP (n = 22) and PT (n = 27). Baseline estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were collected before GnRHa administration and LH and FSH at 60 and 120 min, respectively, after GnRHa administration. RESULTS The girls with CPP presented an increased height Z-score, advanced bone age, and higher baseline LH, FSH, estradiol, and LH/FSH ratio in relation to PT (p < 0.001). Stimulated LH differed significantly between the two groups, and the LH cutoff values were ≥4.29 IU/L (p < 0.001) and ≥3.95 IU/L at 60 and 120 min, respectively (p < 0.001). The LH peak was found at 60 min after stimulation. CONCLUSIONS The GnRHa test is effective in distinguishing CPP from PT, and a single sampling, at 60 min, with LH concentrations above 4.29 may be the parameter of choice with the advantage of greater convenience and practicality.
Collapse
Affiliation(s)
- Kamila Botelho Fernandes de Souza
- Medical Endocrinologist, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Melyna Shayanne Pessôa Veiga
- Medical Endocrinologist, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Gabriela Ráina Ferreira Martins
- Pediatric Endocrinologist Physician, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Adriana Paula da Silva
- Nutritionist Collaborator, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Lívia Grimaldi Abud Fujita
- Endocrinologist, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Janaíne Machado Tomé
- Biomedical Collaborator, Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Heloísa Marcelina da Cunha Palhares
- Physician Collaborator in Pediatric Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| | - Maria de Fátima Borges
- Associated Professor of Endocrinology, Department of Endocrinology and Metabology, Federal University of Triângulo Mineiro, Clinical Hospital, Uberaba, Brazil
| |
Collapse
|
18
|
Soriano-Guillén L, Tena-Sempere M, Seraphim CE, Latronico AC, Argente J. Precocious sexual maturation: Unravelling the mechanisms of pubertal onset through clinical observations. J Neuroendocrinol 2022; 34:e12979. [PMID: 33904190 DOI: 10.1111/jne.12979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 01/05/2023]
Abstract
Puberty is a crucial biological process normally occurring at a specific time during the lifespan, during which sexual and somatic maturation are completed, and reproductive capacity is reached. Pubertal timing is not only determined by genetics, but also by endogenous and environmental cues, including nutritional and metabolic signals. During the last decade, we have learned much regarding the essential roles of kisspeptins and the neuropeptide pathways that converge on these neurones to modulate kisspeptin signalling, as well as neurokinin B and dynorphin, the co-transmitters of Kiss1 neurones in the arcuate nucleus, and the effects of melanocortins on puberty. Indeed, melanocortins are involved in transmitting the regulatory actions of metabolic cues on pubertal maturation. Intracellular metabolic sensors, such as the AMP-activated protein kinase and the fuel-sensing deacetylase SIRT1, have been shown to contribute to puberty. Further understanding of these signals and regulatory circuits will help uncover the intimacies of the central control of puberty, as well as how alterations in metabolic status, ranging from undernutrition to obesity, affect the pubertal process. Precocious puberty is rare and has a clear female predominance. Central precocious puberty (CPP) is diagnosed when premature activation of the hypothalamic-pituitary axis occurs. Its causes are heterogeneous, with alterations of the central nervous system being of special interest, and with environmental factors also playing a role in some cases. During the last decade, several mutations in different genes (including KISS1, KISS1R, MKRN3 and DLK1) that cause CPP have been discovered. Loss-of-function mutations in MKRN3 are the most common monogenic cause of CPP known to date. Here, we review and update what is known regarding the genotype-phenotype relationship in patients with CPP.
Collapse
Affiliation(s)
- Leandro Soriano-Guillén
- Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Pediatrics, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Instituto de Investigación Fundación Jiménez Díaz, Madrid, Spain
| | - Manuel Tena-Sempere
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, Córdoba, Spain
- Hospital Universitario Reina Sofía, Córdoba, Spain
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Córdoba, Spain
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine and Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Carlos E Seraphim
- Laboratory of Hormones and Molecular Genetics, LIM42, Developmental Endocrinology Unit, Department of Internal Medicine, Discipline Endocrinology and Metabolism, Faculty of Medicine, Clinicas Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Ana C Latronico
- Laboratory of Hormones and Molecular Genetics, LIM42, Developmental Endocrinology Unit, Department of Internal Medicine, Discipline Endocrinology and Metabolism, Faculty of Medicine, Clinicas Hospital, University of Sao Paulo, Sao Paulo, Brazil
| | - Jesús Argente
- Department of Pediatrics, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain
| |
Collapse
|
19
|
Choi KH, Park SC. An increasing tendency of precocious puberty among Korean children from the perspective of COVID-19 pandemic effect. Front Pediatr 2022; 10:968511. [PMID: 36090560 PMCID: PMC9454605 DOI: 10.3389/fped.2022.968511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION This study was conducted to investigate changes and new trends over the past 6 years by analyzing the current status of precocious puberty (PP) treatment and treatment costs in Korea between 2016 and 2021. MATERIALS AND METHODS Annual and monthly number of patients diagnosed with PP from 2016 to 2021 were reviewed using the data from Healthcare Bigdata Hub. Annual medical insurance expenses for the treatment of PP were also reviewed. The data were compared by the gender of the patients. RESULTS The number of patients diagnosed with PP rose from 86,352 in 2016 to 166,645 in 2021, while medical expenses rose from KRW 64,111,689,000 in 2016 to KRW 134,642,100,000 in 2021. The percentage of male PP patients increased from 9.21% in 2016 to 19.55% in 2021. CONCLUSION Increasing numbers of Korean patients diagnosed with PP. Consistent with the situation in other countries, the rapid increase in the number of cases since April 2020 appears to be a result of the COVID-19 pandemic. In Korea, this is considered a nationwide phenomenon. Also on the rise is the incidence of PP in males, which appears to be due to an increased awareness of the phenomenon. Further investigations are required to determine the possible causes in increasing prevalence of PP.
Collapse
|
20
|
Popovic J, Geffner ME, Rogol AD, Silverman LA, Kaplowitz PB, Mauras N, Zeitler P, Eugster EA, Klein KO. Gonadotropin-releasing hormone analog therapies for children with central precocious puberty in the United States. Front Pediatr 2022; 10:968485. [PMID: 36268040 PMCID: PMC9577333 DOI: 10.3389/fped.2022.968485] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022] Open
Abstract
Gonadotropin-releasing hormone agonists (GnRHa's) are the standard treatment for children with central precocious puberty (CPP). We aim to present data on available GnRHa options with an easy-to-review table and discuss factors that influence treatment selection. Five GnRHa's are currently FDA-approved and prescribed in the US and published data suggest similar safety and efficacy profiles over the first year of treatment. One- and 3-month intramuscular (IM) leuprolide acetate (LA) have long-term safety and efficacy data and allow for flexible dosing. Six-month IM triptorelin pamoate offers a longer duration of treatment, but without long-term efficacy and outcome data. Six-month subcutaneous (SQ) LA combines a SQ route of injection and long duration of action but lacks long-term efficacy and outcome data. The 12-month SQ histrelin acetate implant avoids injections and offers the longest duration of action, but requires a minor surgical procedure with local or general anesthesia. Factors in treatment selection include route of administration, needle size, injection volume, duration of action, and cost. The current GnRHa landscape provides options with varying benefits and risks, allowing physicians and caregivers to select the most appropriate therapy based on the specific needs and concerns of the child and the caregiver. Agents have different advantages and disadvantages for use, with no one agent displaying superiority.
Collapse
Affiliation(s)
- Jadranka Popovic
- Department of Pediatric Endocrinology, Pediatric Institute, Allegheny Health Network, Pittsburgh, PA, United States
| | - Mitchell E Geffner
- Department of Pediatric Endocrinology, Diabetes and Metabolism, The Saban Research Institute, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Alan D Rogol
- Department of Pediatric Diabetes and Endocrinology, University of Virginia, Charlottesville, VA, United States
| | - Lawrence A Silverman
- Department of Pediatric Endocrinology, Goryeb Children's Hospital Atlantic Health, Morristown, NJ, United States
| | - Paul B Kaplowitz
- Department of Endocrinology, Children's National Hospital, Washington, DC, United States
| | - Nelly Mauras
- Department of Pediatrics, Nemours Children's Health System, Jacksonville, FL, United States
| | - Philip Zeitler
- Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Erica A Eugster
- Department of Pediatric Endocrinology, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States
| | - Karen O Klein
- Department of Pediatrics, Rady Children's Hospital, University of California, San Diego, San Diego, CA, United States
| |
Collapse
|
21
|
Al Alwan I, Alfaraidi H, Al Juraibah F, Al Dubayee M, Babiker A, Tamimi W, Musalli D, Alsheikh M, Badri M. Timing of Puberty and Late Pubertal Height in Saudi Schoolboys: Riyadh Puberty Study II. Int J Endocrinol 2022; 2022:4343596. [PMID: 36311910 PMCID: PMC9613388 DOI: 10.1155/2022/4343596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Puberty has a significant contribution to the final height. Therefore, it is crucial to understand the normal variations in the onset and tempo of puberty in a specific population. In this study, we aimed to provide normative data on the timing of puberty and late pubertal height (LPH) in Saudi schoolboys in Riyadh. METHODS This is a cross-sectional field study (2011-2013) including Saudi schoolboys (grades 1-12; aged 6 to 19 years). Schools were chosen to represent the population from urban and rural areas in the Riyadh region. Pubertal maturity staging for gonads was assessed by measuring testicular size using a Prader orchidometer and assessing the Tanner staging of pubic hair. The marginal mean age was calculated using regression analysis. RESULTS We recruited 1086 schoolboys. The estimated mean age of pubertal onset at G2 was 11.8 (95% CI 11.60-12.0) years, for gonadal development at G3 was 13.2 (95% CI 12.9-13.5), G4 = 15.0 (95% CI 14.7-15.2), and G5 = 16.1 (95% CI 15.9-16.3) years, and for pubic hair stage 2 (PH2) was 12.6 (95% CI 12.4-12.9) years. The estimated time from G2/PH2 to G5/PH5 was 4.3 and 3.9 years, respectively. At the onset of puberty, the mean height was 144.7 cm and it reached 167.8 cm at G5 with a pubertal height gain of 23.1 cm. CONCLUSION Our data present the norms of the timing of puberty and LPH in Saudi schoolboys. Saudi adolescent males are shorter than some European and American comparatives mainly due to shortness during childhood. However, they could have shorter LPH than Turkish, Greek, Thai, and Japanese due to a less pubertal height gain.
Collapse
Affiliation(s)
- Ibrahim Al Alwan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah Specialized Children's Hospital, King Abdulaziz Medical city, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Haifa Alfaraidi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah Specialized Children's Hospital, King Abdulaziz Medical city, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Fahad Al Juraibah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah Specialized Children's Hospital, King Abdulaziz Medical city, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Mohamed Al Dubayee
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah Specialized Children's Hospital, King Abdulaziz Medical city, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Amir Babiker
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah Specialized Children's Hospital, King Abdulaziz Medical city, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Waleed Tamimi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah Specialized Children's Hospital, King Abdulaziz Medical city, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Dania Musalli
- King Abdullah Specialized Children's Hospital, King Abdulaziz Medical city, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Manal Alsheikh
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Motasim Badri
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
22
|
Tenedero CB, Oei K, Palmert MR. An Approach to the Evaluation and Management of the Obese Child With Early Puberty. J Endocr Soc 2022; 6:bvab173. [PMID: 34909516 PMCID: PMC8664756 DOI: 10.1210/jendso/bvab173] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 11/19/2022] Open
Abstract
With the declining age at onset of puberty and increasing prevalence of childhood obesity, early breast development in young obese girls has become a more frequent occurrence. Here, we examine available literature to answer a series of questions regarding how obesity impacts the evaluation and management of precocious puberty. We focus on girls as the literature is more robust, but include boys where literature permits. Suggestions include: (1) Age cutoffs for evaluation of precocious puberty should not differ substantially from those used for nonobese children. Obese girls with confirmed thelarche should be evaluated for gonadotropin-dependent, central precocious puberty (CPP) to determine if further investigation or treatment is warranted. (2) Basal luteinizing hormone (LH) levels remain a recommended first-line test. However, if stimulation testing is utilized, there is a theoretical possibility that the lower peak LH responses seen in obesity could lead to a false negative result. (3) Advanced bone age (BA) is common among obese girls even without early puberty; hence its diagnostic utility is limited. (4) Obesity does not eliminate the need for magnetic resonance imaging in girls with true CPP. Age and clinical features should determine who warrants neuroimaging. (5) BA can be used to predict adult height in obese girls with CPP to inform counseling around treatment. (6) Use of gonadotropin-releasing hormone analogues (GnRHa) leads to increased adult height in obese girls. (7) Obesity should not limit GnRHa use as these agents do not worsen weight status in obese girls with CPP.
Collapse
Affiliation(s)
- Christine B Tenedero
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Krista Oei
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario M5S 1A1, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| |
Collapse
|
23
|
Abstract
Adrenarche is the maturational increase in adrenal androgen production that normally begins in early childhood. It results from changes in the secretory response to adrenocorticotropin (ACTH) that are best indexed by dehydroepiandrosterone sulfate (DHEAS) rise. These changes are related to the development of the zona reticularis (ZR) and its unique gene/enzyme expression pattern of low 3ß-hydroxysteroid dehydrogenase type 2 with high cytochrome b5A, sulfotransferase 2A1, and 17ß-hydroxysteroid dehydrogenase type 5. Recently 11-ketotestosterone was identified as an important bioactive adrenarchal androgen. Birth weight, body growth, obesity, and prolactin are related to ZR development. Adrenarchal androgens normally contribute to the onset of sexual pubic hair (pubarche) and sebaceous and apocrine gland development. Premature adrenarche causes ≥90% of premature pubarche (PP). Its cause is unknown. Affected children have a significantly increased growth rate with proportionate bone age advancement that typically does not compromise growth potential. Serum DHEAS and testosterone levels increase to levels normal for early female puberty. It is associated with mildly increased risks for obesity, insulin resistance, and possibly mood disorder and polycystic ovary syndrome. Between 5% and 10% of PP is due to virilizing disorders, which are usually characterized by more rapid advancement of pubarche and compromise of adult height potential than premature adrenarche. Most cases are due to nonclassic congenital adrenal hyperplasia. Algorithms are presented for the differential diagnosis of PP. This review highlights recent advances in molecular genetic and developmental biologic understanding of ZR development and insights into adrenarche emanating from mass spectrometric steroid assays.
Collapse
Affiliation(s)
- Robert L Rosenfield
- University of Chicago Pritzker School of Medicine, Section of Adult and Pediatric Endocrinology, Metabolism, and Diabetes, Chicago, IL, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
| |
Collapse
|
24
|
Fertility evaluation of infertile women: a committee opinion. Fertil Steril 2021; 116:1255-1265. [PMID: 34607703 DOI: 10.1016/j.fertnstert.2021.08.038] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022]
Abstract
Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all the relevant factors with an initial emphasis on the least invasive methods for detecting the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of in fertile women, and it replaces the document of the same name, last published in 2015 (Fertil Steril 2015;103:e44-50). This guidance is intended for any provider evaluating women for infertility.
Collapse
|
25
|
Cheuiche AV, da Silveira LG, de Paula LCP, Lucena IRS, Silveiro SP. Diagnosis and management of precocious sexual maturation: an updated review. Eur J Pediatr 2021; 180:3073-3087. [PMID: 33745030 DOI: 10.1007/s00431-021-04022-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 12/12/2022]
Abstract
The classic definition of precocious sexual maturation is the development of secondary sexual characteristics before 8 years of age in girls and before 9 years of age in boys. It is classified as central precocious puberty when premature maturation of the hypothalamic-pituitary-gonadal axis occurs, and as peripheral precocious puberty when there is excessive secretion of sex hormones, independent of gonadotropin secretion. Precocious sexual maturation is more common in girls, generally central precocious puberty of idiopathic origin. In boys, it tends to be linked to central nervous system abnormalities. Clinical evaluation should include a detailed history and physical examination, including anthropometric measurements, calculation of growth velocity, and evaluation of secondary sexual characteristics. The main sign to suspect the onset of puberty is breast tissue development (thelarche) in girls and testicular enlargement (≥4 mL) in boys. Hormonal assessment and imaging are required for diagnosis and identification of the etiology. Genetic testing should be considered if there is a family history of precocious puberty or other clinical features suggestive of a genetic syndrome. Long-acting gonadotropin-releasing hormone analogs are the standard of care for central precocious puberty management, while peripheral precocious puberty management depends on the etiology.Conclusion: The aim of this review is to address the epidemiology, etiology, clinical assessment, and management of precocious sexual maturation. What is Known: • The main sign to suspect the onset of puberty is breast tissue development (thelarche) in girls and testicular enlargement (≥4 mL) in boys. The classic definition of precocious sexual maturation is the development of secondary sexual characteristics before 8 years of age in girls and before 9 years of age in boys. • Long-acting gonadotropin-releasing hormone agonist (GnRHa) is the standard of care for CPP management, and adequate hormone suppression results in the stabilization of pubertal progression, a decline in growth velocity, and a decrease in bone age advancement. What is New: • Most cases of precocious sexual maturation are gonadotropin-dependent and currently assumed to be idiopathic, but mutations in genes involved in pubertal development have been identified, such as MKRN3 and DLK1. • A different preparation of long-acting GnRHa is now available: 6-month subcutaneous injection.
Collapse
Affiliation(s)
- Amanda Veiga Cheuiche
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leticia Guimarães da Silveira
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leila Cristina Pedroso de Paula
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Sandra Pinho Silveiro
- Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Endocrine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| |
Collapse
|
26
|
Silverman LA, Han X, Huang H, Near AM, Hu Y. Clinical characteristics and treatment patterns with histrelin acetate subcutaneous implants vs. leuprolide injections in children with precocious puberty: a real-world study using a US claims database. J Pediatr Endocrinol Metab 2021; 34:961-969. [PMID: 34147047 DOI: 10.1515/jpem-2020-0721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Gonadotropin-releasing hormone analogs are the treatment of choice for central precocious puberty (CPP). This study characterizes patients treated with histrelin implant or leuprolide injection. METHODS A US claims database was used to identify patients aged ≤20 years with ≥1 histrelin or leuprolide claim (index treatment) between April 2010 and November 2017 and continuous enrollment ≥3 months before and ≥12 months after the index treatment date. RESULTS Overall, 4,217 patients (histrelin, n=1,001; leuprolide, n=3,216) were identified. The percentage of patients with CPP diagnosis was greater in the histrelin (96.5%) vs. leuprolide (68.8%; p<0.0001) cohort. In patients with CPP (histrelin, n=966; leuprolide, n=2,214), mean age at treatment initiation was similar for histrelin (9.0 ± 2.0 years) and leuprolide (9.1 ± 2.3 years), with >50% of patients aged 6-9 years. Mean treatment duration was significantly longer for histrelin (26.7 ± 14.8 months) vs. leuprolide (14.1 ± 12.1 months; p<0.0001), and was longer in younger patient groups. More patients switched from leuprolide to histrelin (12.3%) than vice versa (3.6%; p<0.0001). Median annual total treatment costs were slightly lower for the histrelin cohort ($23,071 [interquartile range, $16,833-$31,050]) than the leuprolide cohort ($27,021 [interquartile range, $18,314-$34,995]; p<0.0001). CONCLUSIONS Patients with CPP treated with histrelin had a longer duration of treatment, lower rates of index treatment discontinuation, and lower annual treatment costs vs. those treated with leuprolide.
Collapse
Affiliation(s)
- Lawrence A Silverman
- Division of Pediatric Endocrinology, Goryeb Children's Hospital Atlantic Health, Morristown, NJ, USA
| | | | | | | | - Yiqun Hu
- Endo Pharmaceuticals Inc., Malvern, PA, USA
| |
Collapse
|
27
|
Abstract
Onset of puberty, as defined by breast stage 2, appears to be starting at younger ages since the 1940s. There is an ongoing controversy regarding what is normative, as well as what is normal, and the evaluation that is deemed necessary for girls maturing before 8 years of age. There are potential implications of earlier pubertal timing, including psychosocial consequences during adolescence, as well as longer term risks, such as breast cancer and cardiometabolic risks. There are additional consequences derived from slower pubertal tempo, for age of menarche has not decreased as much as age of breast development; these include longer interval between sexual initiation and intentional childbearing, as well as a broadened window of susceptibility to endocrine-related cancers.
Collapse
Affiliation(s)
- Colby E Smith
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center
| | - Frank M Biro
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
28
|
Wu PM, Teng CK, Chou YY, Tu YF. Precocious puberty as a consequence of anti-NMDA receptor encephalitis in children. Pediatr Neonatol 2021; 62:361-368. [PMID: 33846107 DOI: 10.1016/j.pedneo.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/20/2020] [Accepted: 03/11/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is one of the most common autoimmune encephalitis in children. Most children recovered well after anti-NMDA receptor encephalitis. However, the NMDA receptor network functions are critical for the developing brain in children. The long-term consequences in pediatric patients of anti-NMDA receptor encephalitis are very infrequently reported. METHODS This case series study retrospectively enrolled 10 children aged below 18 years old with antibody-proved anti-NMDA receptor encephalitis in a tertiary medical center from 2010 to 2019. Long-term neurological consequences of anti-NMDA receptor encephalitis in children were followed. RESULTS One boy and nine girls were enrolled with a median onset age of 3.6 years. The most common initial presentation was verbal reduction and psychiatric symptoms soon after some flu-like prodromal symptoms. Nearly all patients then developed decreased level of consciousness, mutism, seizures and orofacial-lingual dyskinesia. Autonomic instability occurred in 5 patients, particularly in pre-pubertal children. Only one adolescent patient had ovarian teratoma. All patients survived after immunotherapy and were followed for 5.8 ± 3.3 years after discharge. Four had epilepsy within 2 years after encephalitis, four had a cognitive deficit, one had mild psychiatric symptoms of hallucination, and none had residual involuntary movements. Moreover, two pre-pubertal children developed central precocious puberty about 3 years after encephalitis, and one required gonadotropin-releasing hormone agonist treatment. CONCLUSION Central precocious puberty could be a consequence of anti-NMDA receptor encephalitis in the pre-pubertal children. The pediatrician should pay attention to its occurrence at follow-up.
Collapse
Affiliation(s)
- Po-Ming Wu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Chao-Ku Teng
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Yen-Yin Chou
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Yi-Fang Tu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan.
| |
Collapse
|
29
|
Houtrow A, Elias ER, Davis BE. Promoting Healthy Sexuality for Children and Adolescents With Disabilities. Pediatrics 2021; 148:peds.2021-052043. [PMID: 34183359 DOI: 10.1542/peds.2021-052043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This clinical report updates a 2006 report from the American Academy of Pediatrics titled "Sexuality of Children and Adolescents With Developmental Disabilities." The development of a healthy sexuality best occurs through appropriate education, absence of coercion and violence, and developmental acquisition of skills to navigate feelings, desires, relationships, and social pressures. Pediatric health care providers are important resources for anticipatory guidance and education for all children and youth as they understand their changing bodies, feelings, and behaviors. Yet, youth with disabilities and their families report inadequate education and guidance from pediatricians regarding sexual health development. In the decade since the original clinical report was published, there have been many advancements in the understanding and care of children and youth with disabilities, in part because of an increased prevalence and breadth of autism spectrum disorder as well as an increased longevity of individuals with medically complex and severely disabling conditions. During this same time frame, sexual education in US public schools has diminished, and there is emerging evidence that the attitudes and beliefs of all youth (with and without disability) about sex and sexuality are being formed through media rather than formal education or parent and/or health care provider sources. This report aims to provide the pediatric health care provider with resources and tools for clinical practice to address the sexual development of children and youth with disabilities. The report emphasizes strategies to promote competence in achieving a healthy sexuality regardless of physical, cognitive, or socioemotional limitations.
Collapse
Affiliation(s)
- Amy Houtrow
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Ellen Roy Elias
- School of Medicine, University of Colorado and Special Care Clinic, Children's Hospital Colorado, Aurora, Colorado
| | | | | |
Collapse
|
30
|
Cemeroglu AP, Kaval D, Ozcan O. Etiology of Increased Referrals for Evaluation of Early Puberty in a Tertiary Care Center in Turkey: True Precocious Puberty, Obesity, or Parental Anxiety and Lack of Knowledge? Glob Pediatr Health 2021; 8:2333794X211009096. [PMID: 33889682 PMCID: PMC8040381 DOI: 10.1177/2333794x211009096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 01/22/2023] Open
Abstract
There has been a global increase in pediatric endocrinology referrals for the concerns of early puberty. The objective of this study was to determine the reasons behind this increase. A retrospective cross-sectional study was designed to analyze the clinical characteristics of patients seen for the concerns of early puberty in pediatric endocrinology clinic of a tertiary care center (Study A). Additionally, a prospective questionnaire study was designed to assess the knowledge and concerns of the mothers regarding the timing of puberty in girls (Study B). In study A, of the 305 girls, 42.9% were overweight/obese, 68.5% either had normal pubertal development for age or were prepubertal, 1 had non-classic congenital adrenal hyperplasia, and 2 had central precocious puberty. Of the 36 boys, 56% were overweight/obese, 64% either had normal pubertal development for age or were prepubertal, and 1 had non-classic congenital adrenal hyperplasia. In study B, 95% of the participants thought the girls have been developing earlier, over 10% considered the first sign of puberty to be normal after the age 14 years and 12.4% considered menarche to be normal after age 14 years. The common sources of anxiety for the participants regarding the earlier timing of puberty were psychosocial issues and short final height. In conclusion, many parents had wrong beliefs/information about the normal timing of puberty and were concerned about precocious puberty in girls. Education of parents about the normal timing of puberty may help avoiding unnecessary referrals, parental anxiety, and financial burden to the society.
Collapse
Affiliation(s)
| | - Damlanur Kaval
- Baskent University School of Medicine, Pediatric Endocrinology, Ankara, Turkey
| | - Ozan Ozcan
- Baskent University School of Medicine, Pediatric Endocrinology, Ankara, Turkey
| |
Collapse
|
31
|
Bai GL, Hu KL, Huan Y, Wang X, Lei L, Zhang M, Guo CY, Chang HS, Zhao LB, Liu J, Shen ZF, Wang XL, Ni X. The Traditional Chinese Medicine Fuyou Formula Alleviates Precocious Puberty by Inhibiting GPR54/GnRH in the Hypothalamus. Front Pharmacol 2021; 11:596525. [PMID: 33551803 PMCID: PMC7859969 DOI: 10.3389/fphar.2020.596525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to explore the effect of the traditional Chinese medicine Fuyou formula on precocious puberty (PP). The Fy formula may exert an effect in female rats with PP and GT-7 cells through the GPR54/GnRH signaling pathway. To confirm the effect of the Fy formula on PP through the GPR54/GnRH signaling pathway, we first treated GT1-7 cells with the Fy formula and observed changes in the expression of related genes and proteins and in GnRH secretion. Then, we randomly divided young female Sprague-Dawley rats into the control group, model group, leuprorelin group and the Fy formula group. A PP model was established by injection of danazol on postnatal day 5, and the Fy formula was administered on PND15. The time of vaginal opening, the wet weights of the ovary and uterus, serum hormone levels and the expression of hypothalamic-related genes were observed. We found that the Fy formula delayed vaginal opening, decreased the wet weights and coefficients of the ovary and uterus, decreased the levels of serum hormones (E2, follicle-stimulating hormone and luteinizing hormone) and the cellular GnRH level, and downregulated the gene expression of Kiss1, GPR54 and GnRH in the hypothalamus and the gene and protein expression of GPR54 and GnRH in GT1-7 cells. In conclusion, the Fy formula may alleviate PP via the GPR54/GnRH signaling pathway.
Collapse
Affiliation(s)
- Guo-Liang Bai
- Clinical Research Center, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.,State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Key Laboratory of Polymorphic Drugs of Beijing, Institute of Materia Medica, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Kai-Li Hu
- Department of Pharmacology, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Huan
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Key Laboratory of Polymorphic Drugs of Beijing, Institute of Materia Medica, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xing Wang
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Key Laboratory of Polymorphic Drugs of Beijing, Institute of Materia Medica, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lei Lei
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Key Laboratory of Polymorphic Drugs of Beijing, Institute of Materia Medica, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Meng Zhang
- Clinical Research Center, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Chun-Yan Guo
- Clinical Research Center, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Hong-Sheng Chang
- Department of Pharmacology, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, China
| | - Li-Bo Zhao
- Clinical Research Center, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Jing Liu
- Clinical Research Center, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Zhu-Fang Shen
- State Key Laboratory of Bioactive Substances and Functions of Natural Medicines, Key Laboratory of Polymorphic Drugs of Beijing, Institute of Materia Medica, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiao-Ling Wang
- Clinical Research Center, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xin Ni
- Clinical Research Center, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| |
Collapse
|
32
|
Baldo F, Marin M, Murru FM, Barbi E, Tornese G. Dealing With Brain MRI Findings in Pediatric Patients With Endocrinological Conditions: Less Is More? Front Endocrinol (Lausanne) 2021; 12:780763. [PMID: 35095759 PMCID: PMC8791386 DOI: 10.3389/fendo.2021.780763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/20/2021] [Indexed: 12/22/2022] Open
Abstract
Neuroimaging is a key tool in the diagnostic process of various clinical conditions, especially in pediatric endocrinology. Thanks to continuous and remarkable technological developments, magnetic resonance imaging can precisely characterize numerous structural brain anomalies, including the pituitary gland and hypothalamus. Sometimes the use of radiological exams might become excessive and even disproportionate to the patients' medical needs, especially regarding the incidental findings, the so-called "incidentalomas". This unclarity is due to the absence of well-defined pediatric guidelines for managing and following these radiological findings. We review and summarize some indications on how to, and even if to, monitor these anomalies over time to avoid unnecessary, expensive, and time-consuming investigations and to encourage a more appropriate follow-up of brain MRI anomalies in the pediatric population with endocrinological conditions.
Collapse
Affiliation(s)
| | - Maura Marin
- University of Trieste, Trieste, Italy
- *Correspondence: Maura Marin,
| | - Flora Maria Murru
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
| |
Collapse
|
33
|
Subramanian A, Idkowiak J, Toulis KA, Thangaratinam S, Arlt W, Nirantharakumar K. Pubertal timing in boys and girls born to mothers with gestational diabetes mellitus: a systematic review. Eur J Endocrinol 2021; 184:51-64. [PMID: 33112263 PMCID: PMC7707806 DOI: 10.1530/eje-20-0296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/08/2020] [Indexed: 01/11/2023]
Abstract
CONTEXT The incidence of gestational diabetes mellitus (GDM) has been on the rise, driven by maternal obesity. In parallel, pubertal tempo has increased in the general population, driven by childhood obesity. OBJECTIVE To evaluate the available evidence on pubertal timing of boys and girls born to mothers with GDM. DATA SOURCES We searched MEDLINE, EMBASE, CINAHL Plus, Cochrane library and grey literature for observational studies up to October 2019. STUDY SELECTION AND EXTRACTION Two reviewers independently selected studies, collected data and appraised the studies for risk of bias. Results were tabulated and narratively described as reported in the primary studies. RESULTS Seven articles (six for girls and four for boys) were included. Study quality score was mostly moderate (ranging from 4 to 10 out of 11). In girls born to mothers with GDM, estimates suggest earlier timing of pubarche, thelarche and menarche although for each of these outcomes only one study each showed a statistically significant association. In boys, there was some association between maternal GDM and earlier pubarche, but inconsistency in the direction of shift of age at onset of genital and testicular development and first ejaculation. Only a single study analysed growth patterns in children of mothers with GDM, describing a 3-month advancement in the age of attainment of peak height velocity and a slight increase in pubertal tempo. CONCLUSIONS Pubertal timing may be influenced by the presence of maternal GDM, though current evidence is sparse and of limited quality. Prospective cohort studies should be conducted, ideally coupled with objective biochemical tests.
Collapse
Affiliation(s)
| | - Jan Idkowiak
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
- Correspondence should be addressed to J Idkowiak;
| | | | - Shakila Thangaratinam
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
34
|
Cao R, Liu J, Fu P, Zhou Y, Li Z, Liu P. The Diagnostic Utility of the Basal Luteinizing Hormone Level and Single 60-Minute Post GnRH Agonist Stimulation Test for Idiopathic Central Precocious Puberty in Girls. Front Endocrinol (Lausanne) 2021; 12:713880. [PMID: 34456870 PMCID: PMC8387794 DOI: 10.3389/fendo.2021.713880] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/23/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The present study aimed to assess the diagnostic utility of the Luteinizing hormone (LH) levels and single 60-minute post gonadotropin-releasing hormone (GnRH) agonist stimulation test for idiopathic central precocious puberty (CPP) in girls. METHODS Data from 1,492 girls diagnosed with precocious puberty who underwent GnRH agonist stimulation testing between January 1, 2016, and October 8, 2020, were retrospectively reviewed. LH levels and LH/follicle-stimulating hormone (FSH) ratios were measured by immuno-chemiluminescence assay before and at several timepoints after GnRH analogue stimulation testing. Mann-Whitney U test, Spearman's correlation, χ2 test, and receiver operating characteristic (ROC) analyses were performed to determine the diagnostic utility of these hormone levels. RESULTS The 1,492 subjects were split into two groups: an idiopathic CPP group (n = 518) and a non-CPP group (n = 974). Basal LH levels and LH/FSH ratios were significantly different between the two groups at 30, 60, 90, and 120 minutes after GnRH analogue stimulation testing. Spearman's correlation analysis showed the strongest correlation between peak LH and LH levels at 60 minutes after GnRH agonist stimulation (r = 0.986, P < 0.001). ROC curve analysis revealed that the 60-minute LH/FSH ratio yielded the highest consistency, with an area under the ROC curve (AUC) of 0.988 (95% confidence interval [CI], 0.982-0.993) and a cut-off point of 0.603 mIU/L (sensitivity 97.3%, specificity 93.0%). The cut-off points of basal LH and LH/FSH were 0.255 mIU/L (sensitivity 68.9%, specificity 86.0%) and 0.07 (sensitivity 73.2%, specificity 89.5%), respectively, with AUCs of 0.823 (95% CI, 0.799-0.847) and 0.843 (95% CI, 0.819-0.867), respectively. CONCLUSIONS A basal LH value greater than 0.535 mIU/L can be used to diagnose CPP without a GnRH agonist stimulation test. A single 60-minute post-stimulus gonadotropin result of LH and LH/FSH can be used instead of a GnRH agonist stimulation test, or samples can be taken only at 0, 30, and 60 minutes after a GnRH agonist stimulation test. This reduces the number of blood draws required compared with the traditional stimulation test, while still achieving a high level of diagnostic accuracy.
Collapse
Affiliation(s)
- Ruixue Cao
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinrong Liu
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Pinguo Fu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yonghai Zhou
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhe Li
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peining Liu
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
35
|
Seymen Karabulut G, Atar M, Çizmecioğlu Jones FM, Hatun Ş. Girls with Premature Thelarche Younger than 3 Years of Age May Have Stimulated Luteinizing Hormone Greater than 10 IU/L. J Clin Res Pediatr Endocrinol 2020; 12:377-382. [PMID: 32349465 PMCID: PMC7711634 DOI: 10.4274/jcrpe.galenos.2020.2019.0202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/16/2020] [Indexed: 12/01/2022] Open
Abstract
Objective Premature thelarche (PT) is defined as isolated breast development in girls before eight years of age. Gonadotropin-releasing hormone (GnRH) stimulation test is sometimes used to distinguish between PT and central precocious puberty (CPP), although the interpretation of the test at early ages is challenging. The objective of this study was to determine the follicle stimulating hormone (FSH) and luteinizing hormone (LH) responses to GnRH stimulation in girls with PT below 3 years of age. Methods A standardized GnRH stimulation test, bone age and pelvic ultrasound were evaluated and those without pubertal progression after a minimum of one-year follow up were included in the study. Results On GnRH stimulation test, the median (range) baseline LH was 0.29 (0.10-0.74) IU/L, baseline FSH was 4.96 (3.18-7.05) mIU/mL, and the peak median LH was 5.75 (3.31-8.58) IU/L with the peak mean±standard deviation FSH was 40.38±20.37 mIU/mL. Among the patients, 33.3% (n=10) had baseline LH >0.3 IU/L, 67% (n=20) had peak LH >5 IU/l and 16.6% (n=5) >10 IU/L. The mean peak LH/FSH ratio was 0.17±0.09 and was ≤0.43 in all participants. Conclusion Although consensus statements usually define baseline LH >0.3-0.5 IU/L, peak LH >5 IU/L, and LH/FSH ratios >0.66-1.0 as diagnostic cut-offs for CPP, in children below 3 years of age, the baseline and peak LH values may be similar to pubertal values, possibly due to mini-puberty. A dominant FSH response on GnRH stimulation test is more valuable than the peak LH response in the diagnosis of PT.
Collapse
Affiliation(s)
- Gülcan Seymen Karabulut
- Ümraniye Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Müge Atar
- Süleyman Demirel University Faculty of Medicine, Department of Pediatric Endocrinology, Isparta, Turkey
| | | | - Şükrü Hatun
- Koç University Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| |
Collapse
|
36
|
Reina-Alzate J, Saldarriaga MF, Londoño-Arévalo MA, Osorio JD, Tamayo-Ortiz MM. Correlation between imaging findings and hormonal markers at the onset of puberty in girls. RADIOLOGIA 2020; 65:S0033-8338(20)30136-3. [PMID: 33198960 DOI: 10.1016/j.rx.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/06/2020] [Accepted: 09/17/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study aimed to determine the diagnostic performance of transabdominal pelvic ultrasonography and bone age in identifying the onset of puberty in girls at the Clínica Las Américas in Medellín, Colombia. METHODS We included girls aged ≤ 11 years referred to our clinic between March 2016 and March 2019 for signs of puberty. We compared the findings on pelvic and breast ultrasonography and bone age versus the baseline measurement of luteinizing hormone (LH) in serum, used as the reference standard for identifying the onset of puberty. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios, analyzing subgroups of patients of different ages. RESULTS We analyzed 43 patients. Ultrasound assessment of breast development had the highest sensitivity (94.1%) of all the imaging parameters evaluated, but its specificity was low. However, characteristics such as the length of the body of the uterus> 3.0cm and the presence of endometrial echoes were highly specific for identifying the onset of puberty, particularly in patients aged ≤ 8 years. CONCLUSION Pelvic ultrasonography, ultrasonographic assessment of Tanner stage of breast development, and the evaluation of bone age are useful tools for the imaging confirmation of the onset of puberty. The results of this study support the use of these techniques in clinical practice in the workup for pubertal disorders in girls.
Collapse
Affiliation(s)
- J Reina-Alzate
- Departamento de Radiología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - M F Saldarriaga
- Departamento de Radiología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - M A Londoño-Arévalo
- Médica radióloga, egresada de la Pontificia Universidad Javeriana, Bogotá, Colombia
| | - J Diego Osorio
- Dirección científica, Clínica Las Américas, Medellín, Colombia
| | - M M Tamayo-Ortiz
- Departamento de Radiología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Departamento de Radiología, Clínica Las Américas, Medellín, Colombia
| |
Collapse
|
37
|
Roberts SA, Kaiser UB. GENETICS IN ENDOCRINOLOGY: Genetic etiologies of central precocious puberty and the role of imprinted genes. Eur J Endocrinol 2020; 183:R107-R117. [PMID: 32698138 PMCID: PMC7682746 DOI: 10.1530/eje-20-0103] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022]
Abstract
Pubertal timing is regulated by the complex interplay of genetic, environmental, nutritional and epigenetic factors. Criteria for determining normal pubertal timing, and thus the definition of precocious puberty, have evolved based on published population studies. The significance of the genetic influence on pubertal timing is supported by familial pubertal timing and twin studies. In contrast to the many monogenic causes associated with hypogonadotropic hypogonadism, only four monogenic causes of central precocious puberty (CPP) have been described. Loss-of-function mutations in Makorin Ring Finger Protein 3(MKRN3), a maternally imprinted gene on chromosome 15 within the Prader-Willi syndrome locus, are the most common identified genetic cause of CPP. More recently, several mutations in a second maternally imprinted gene, Delta-like noncanonical Notch ligand 1 (DLK1), have also been associated with CPP. Polymorphisms in both genes have also been associated with the age of menarche in genome-wide association studies. Mutations in the genes encoding kisspeptin (KISS1) and its receptor (KISS1R), potent activators of GnRH secretion, have also been described in association with CPP, but remain rare monogenic causes. CPP has both short- and long-term health implications for children, highlighting the importance of understanding the mechanisms contributing to early puberty. Additionally, given the role of mutations in the imprinted genes MKRN3 and DLK1 in pubertal timing, other imprinted candidate genes should be considered for a role in puberty initiation.
Collapse
Affiliation(s)
- Stephanie A. Roberts
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ursula B. Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
38
|
The Age Distribution among Children Seeking Medical Treatment for Precocious Puberty in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186765. [PMID: 32957428 PMCID: PMC7559721 DOI: 10.3390/ijerph17186765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022]
Abstract
Objective: Children with precocious puberty (PP) may have increased physiological and psychological problems. In this study, we aimed to explore the trend of parents seeking medical care for their children with precocious puberty. Methods: The Taiwan National Health Insurance Research Dataset (NHIRD) was used to estimate the prevalence (2000–2013) and incidence (2002–2013) of PP (ICD-9 code: 259.1) among boys aged 0–11 years and girls aged 0–10 years. The proportions of PP management within 1 year from the date of first diagnosis were also compared between two periods (2002–2007 and 2008–2012). The trends of PP prevalence or incidence were determined by join-point regression. Results: In 2000, 309 boys and 2706 girls had at least one visit for PP, the crude prevalence rates (per 10,000 persons) were 0.99 (95% confidence interval, 95% CI 0.87–1.14) and 13.56 (95% CI 13.01–14.13) in boys and girls, respectively. In 2013, the crude prevalence rates increased to 7.01 (95% CI 6.56–7.84) and 110.95 (95% CI 108.97–112.96) in boys and girls, respectively. A total of 2584 girls and 207 boys with incident PP cases were identified in 2002, and 7498 girls and 739 boys were identified in 2013. For girls, the incidence rates (per 10,000 person-years) were 16.17 (95% CI 15.55–16.80) and 70.23 (95% CI 68.65–71.83) in 2002 and 2013, respectively. For boys, the incidence rates were 1.09 (95% CI 0.95–1.24) and 5.72 (95% CI 5.32–6.15) in 2002 and 2013, respectively. The sex ratio (F:M) of the incidence of PP cases was 14.89 in 2002 and 12.28 in 2013. Conclusion: In this study, from 2000 to 2013, the frequency of visiting pediatric endocrinology outpatient clinics for precocious puberty increased in both genders. We advocate that it is important to pay increased attention to children’s health, environmental hormones, and diet. Researchers should consider how to survey precocious puberty and offer parents more education to avoid the waste of medical resources or delays in seeking medical care.
Collapse
|
39
|
Santos MC, Limão S, Ferreira P. Exacerbated mini-puberty of infancy in an ex-extreme preterm girl. BMJ Case Rep 2020; 13:13/9/e235492. [PMID: 32878858 DOI: 10.1136/bcr-2020-235492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Vaginal bleeding can occur shortly after delivery in 3%-5% of newborns as a consequence of placental hormone withdrawal . Although usually benign, its differential diagnosis includes central precocious puberty, tumours and other pathological conditions. A girl born at 26 weeks of gestation presented with five episodes of vaginal bleeding, each lasting less than a week, initiated at 4 months of age. Luteinising hormone and oestradiol levels were in the pubertal range. Later, she exhibited breast development, with no other pubertal signs. An ultrasonography test revealed an impregnated endometrium and a right ovarian cyst with 43 mm of diameter. A cranioencephalic MRI was unremarkable. Clinicians adopted expectant management and there was clinical, hormonal and radiological resolution in 3 months. The spontaneous resolution suggested mini-puberty of infancy. This is usually an asymptomatic condition, but to date, four cases of an exacerbated form in extremepremature infants have been reported. Long-term follow-up data are missing.A girl born at 26 weeks of gestation presented with five episodes of vaginal bleeding, each lasting less than a week, initiated at 4 months of age. Luteinising hormone and oestradiol levels were in the pubertal range. Later, she exhibited breast development, with no other pubertal signs. An ultrasonography test revealed an impregnated endometrium and a right ovarian cyst with 43 mm of diameter. A cranioencephalic MRI was unremarkable. Clinicians adopted expectant management and there was clinical, hormonal and radiological resolution in 3 months. The spontaneous resolution suggested mini-puberty of infancy. This is usually an asymptomatic condition, but to date, four cases of an exacerbated form in extremepremature infants have been reported. Long-term follow-up data are missing.
Collapse
Affiliation(s)
| | - Sara Limão
- Serviço de Pediatria, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Patrícia Ferreira
- Serviço de Pediatria, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| |
Collapse
|
40
|
Soto J, Pereira A, Busch AS, Almstrup K, Corvalan C, Iñiguez G, Juul A, Mericq V. Reproductive hormones during pubertal transition in girls with transient Thelarche. Clin Endocrinol (Oxf) 2020; 93:296-304. [PMID: 32419140 DOI: 10.1111/cen.14248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 01/26/2023]
Abstract
CONTEXT Transient thelarche (TT), that is, the appearance, regression and subsequent reappearance of breast buds, is a frequent phenomenon, but little is known about pubertal transition in these girls. OBJECTIVE To describe pubertal progression, growth, genotypes, reproductive hormones and growth factors in girls with TT compared to those who do not present TT (non-TT). DESIGN Retrospective analysis of a longitudinal population-based study. PATIENTS OR OTHER PARTICIPANTS Girls (n = 508) of the Chilean Growth and Obesity cohort. MEASUREMENTS Pubertal progression, reproductive hormones, follicle stimulating hormone (FSH) beta subunit/FSH receptor gene single nucleotide polymorphisms and growth. RESULTS Thirty-seven girls (7.3%) were presented TT. These girls entered puberty by pubarche more frequently (51%) than girls with normal progression (non-TT; n = 471; 23%, P = .005). Girls with TT who were under 8 years old had lower androgens, anti-Müllerian hormone (AMH), luteinizing hormone (LH) and oestradiol (all P < .05) than older girls with TT. At the time of Tanner breast stage 2 (B2), girls with TT had higher androgens, LH, FSH, IGF1, LH, insulin and oestradiol (P < .01) than at the time of TT. TT girls were older at B2 (10.3 ± 1.1 vs. 9.2 ± 1.2 years, P < .001) and menarche (12.3 ± 0.8 vs. 12.0 ± 1.0 years, P = .040) than their counterparts (non-TT). No differences in anthropometric variables or FSHB/FSHR genotypes were detected. CONCLUSION Transient thelarche is a frequent phenomenon that does not appear to be mediated by hypothalamic-pituitary-gonadal axis activation or by adiposity. Hormonal differences between earlier TT and later TT suggest that their mechanisms are different.
Collapse
Affiliation(s)
- Julio Soto
- Faculty of Medicine, Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| | - Ana Pereira
- Faculty of Medicine, Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
| | - Alexander Siegfried Busch
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - German Iñiguez
- Faculty of Medicine, Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| | - Anders Juul
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Veronica Mericq
- Faculty of Medicine, Institute of Maternal and Child Research (IDIMI), University of Chile, Santiago, Chile
| |
Collapse
|
41
|
Affiliation(s)
- Paul B Kaplowitz
- Division of Endocrinology, Children's National Hospital, George Washington University School of Medicine and the Health Sciences, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
| |
Collapse
|
42
|
Su H, Su Z, Pan L, Wang L, Xu Z, Peng G, Li X. Factors affecting bone maturation in Chinese girls aged 4-8 years with isolated premature thelarche. BMC Pediatr 2020; 20:356. [PMID: 32727432 PMCID: PMC7388507 DOI: 10.1186/s12887-020-02256-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Abstract
Background In isolated premature thelarche (IPT) girls, bone age (BA) is considered consistent with chronological age. However, some IPT girls confirmed by gonadotropin-releasing hormone (GnRH) stimulation test could show another trend. We analysed BA and possible potentiating factors in a selected group of girls aged 4–8 years with IPT. Methods IPT girls confirmed by GnRH stimulation test aged 4–8 years hospitalized from January 2015 to April 2018 at Shenzhen Children’s Hospital were included in this retrospective study. They were divided into two groups with advanced BA of 2 years as the cut-off. Body mass index (BMI) and hormone levels were the main outcome measures, and regression analysis was used to identify independent risk factors. IPT girls were divided into subgroups according to the levels of BMI standard deviation score (SDS), insulin-like growth factor-1 (IGF-1) SDS and dehydroepiandrosterone sulfate (DHEAS) SDS for comparisons of advanced BA. Results Overall, 423 subjects were included and classified into the advanced BA group (48.7%, n = 206) and control group (51.3%, n = 217). The advanced BA group had significantly higher BMI SDS, serum DHEAS SDS, IGF-1 SDS, androstenedione and fasting insulin and significantly lower sex hormone binding globulin (all p < 0.001). Serum IGF-1 SDS (OR = 1.926, p<0.001), BMI SDS (OR = 1.427, p = 0.001) and DHEAS SDS (OR = 1.131, p = 0.005) were independent risk factors for significantly advanced BA. In the multiple linear regression model, serum IGF-1 SDS, BMI SDS and DHEAS SDS were the strongest predictors of advanced BA, accounting for 19.3% of the variance. According to BMI, 423 patients were classified into three groups: normal weight (56.03%, n = 237), overweight (19.15%, n = 81) and obesity (24.82%, n = 105). The proportion of advanced BA in obesity group was significantly higher than those of normal weight and overweight groups (χ2 = 18.088, p<0.001). In the subgroup with normal weight, higher serum IGF-1 SDS (p = 0.009) and DHEAS SDS (p = 0.003) affected BA advancement independent of BMI SDS. Conclusions Girls with IPT confirmed by GnRH stimulation test aged 4–8 years might have significantly advanced BA. Obesity was highly associated with advanced BA. Age-specific serum IGF-1 SDS and DHEAS SDS were risk factors for BA advancement independent of BMI.
Collapse
Affiliation(s)
- Huiping Su
- Department of Endocrinology, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, 518038, Shenzhen, Guangdong Province, People's Republic of China
| | - Zhe Su
- Department of Endocrinology, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, 518038, Shenzhen, Guangdong Province, People's Republic of China.
| | - Lili Pan
- Department of Endocrinology, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, 518038, Shenzhen, Guangdong Province, People's Republic of China
| | - Li Wang
- Department of Endocrinology, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, 518038, Shenzhen, Guangdong Province, People's Republic of China
| | - Zhongwei Xu
- Department of Endocrinology, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, 518038, Shenzhen, Guangdong Province, People's Republic of China
| | - Gang Peng
- Department of Adolescent Gynecology, Shenzhen Children's Hospital, Shenzhen, China
| | - Xianglei Li
- Department of Endocrinology, Shenzhen Children's Hospital, No. 7019, Yitian Road, Futian District, 518038, Shenzhen, Guangdong Province, People's Republic of China
| |
Collapse
|
43
|
Abstract
Evaluation of the child with abnormal pubertal development can be challenging for the primary care provider. Understanding the factors associated with timing of pubertal onset and the normal sequence of pubertal changes is useful in evaluation of children with puberty disorders. A thorough workup includes assessment of growth rate, Tanner staging, and rate of pubertal progression, in addition to an extensive history and physical examination to identify signs and symptoms of disorders associated with abnormal pubertal timing. Initial diagnostic studies will most often include a bone age, levels of gonadotropins, and levels of estradiol (for girls) or testosterone (for boys).
Collapse
Affiliation(s)
- Swati V Elchuri
- Pediatric Diagnostic Center, 300 Hillmont Avenue, Building 340, Suite 302, Ventura, CA 93003, USA
| | - Jennifer J Momen
- Division of Physician Assistant Studies, Department of Human Performance and Applied Exercise Science, West Virginia University School of Medicine, 1 Medical Center Drive, PO Box 9226, Morgantown, WV 26506-9226, USA.
| |
Collapse
|
44
|
Affiliation(s)
- Stephen H Bradley
- Academic Unit of Primary Care, University of Leeds, Leeds, UK
- York Street Practice, Leeds, UK
| | | | | | | |
Collapse
|
45
|
Almutlaq N, O'Neil J, Fuqua JS. Central precocious puberty in spina bifida children: Guidelines for the care of people with spina bifida. J Pediatr Rehabil Med 2020; 13:557-563. [PMID: 33325409 PMCID: PMC7838954 DOI: 10.3233/prm-200728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Children with spina bifida are at greater risk of developing central precocious puberty (CPP) compared to others. Therefore, early recognition and timely referral for further evaluation by a pediatric endocrinologist allows appropriate management that reduces the impact of CPP. This article discusses the diagnosis and management of CPP in children with spina bifida. This guideline was developed for SB Transition Healthcare Guidelines from the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida.
Collapse
Affiliation(s)
- Nourah Almutlaq
- Division of Pediatric Endocrinology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph O'Neil
- Division of Developmental Pediatrics, Riley Hospital for Children, Indianapolis, IN, USA
| | - John S Fuqua
- Division of Pediatric Endocrinology, Riley Hospital for Children, Indianapolis, IN, USA
| |
Collapse
|
46
|
Bellotto E, Monasta L, Pellegrin MC, Bossini B, Tamaro G, Conte MS, Faleschini E, Barbi E, Tornese G. Pattern and Features of Pediatric Endocrinology Referrals: A Retrospective Study in a Single Tertiary Center in Italy. Front Pediatr 2020; 8:580588. [PMID: 33123505 PMCID: PMC7567164 DOI: 10.3389/fped.2020.580588] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction: The knowledge of the pattern and the features of pediatric endocrinology referrals is crucial to optimize resources and guide public health interventions. We explored the numbers and the reasons for referral to a pediatric endocrinology outpatient clinic and investigated their features in terms of assignment of priority ranks, sex, age differences, the prevalence of pathological findings among referred cases, and the agreement among referrals, final diagnosis, treatment, and follow-up. Methods: Retrospective study with data collection for pediatric endocrinology first visits between November 2012 and February 2019 in a tertiary center. Results: A total of 1930 first visits were performed with an overall number of referrals of 2,165, and an increasing trend over the years. The most frequent referral reasons were slow growth, precocious puberty, and obesity; 14% of visits were classified as "urgent" (<7 days), 35% as "deferrable" (<30 days), and 51% as "planned" (<180 days). Sex and age differences among referrals were detected, with criticality in the appropriate timing for referral. Thirty-eight percent of patients had pathological findings. In 4% of the cases the final diagnosis was not concordant with the reason for referral. Treatment was prescribed in 35% of cases, and 67% returned at least for one follow-up visit. Conclusion: The study highlighted the need to target medical education of primary care on the definition of priority ranks, the need for more extended observation periods for subclinical or para-physiological conditions, the appropriate timing for referral, based on the definition of conditions or the best window of intervention.
Collapse
Affiliation(s)
| | - Lorenzo Monasta
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | - Maria Sole Conte
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Elena Faleschini
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Egidio Barbi
- University of Trieste, Trieste, Italy.,Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| |
Collapse
|
47
|
The relationship between lavender and tea tree essential oils and pediatric endocrine disorders: A systematic review of the literature. Complement Ther Med 2019; 49:102288. [PMID: 32147050 DOI: 10.1016/j.ctim.2019.102288] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/19/2019] [Accepted: 12/19/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Essential oils are common ingredients in personal care products, little is known about the effects of chronic exposure to these ingredients in human health. It has been suggested that these two essential oils cause prepubertal gynecomastia and premature thelarche in children. The purpose of this study was to systematically review the evidence related to the proposed link between these essential oils and endocrine disruption METHODS: This study sought to investigate the proposed link between LEO and TTEO and endocrine disrupting outcomes by identifying and evaluating the clinical evidence regarding this topic. Studies qualified if the participants included prepubertal children who have experienced either prepubertal gynecomastia or premature thelarche. The Case Series Critical Appraisal Tool (CSCAT) was used to identify the reliability of the identified case series. The potential for evidence of causality was evaluated using the tool proposed by Murad. RESULTS A total of four manuscripts were identified, describing a total of eleven cases reported to have experienced both the exposure and the outcome. Reporting of inclusion, demographic data, clinical data, and the potential for causality was found to be insufficient. This study did not find evidence to support the claim that tea tree essential oil is related to endocrine disruption in children, and little to no evidence to substantiate the proposed link between lavender essential oil and endocrine disruption in children. CONCLUSION Because this potential link remains a concern among pediatric care providers and parents, epidemiological research to address the proposed link is needed.
Collapse
|
48
|
Coincidental Central Precocious Puberty and Wilms Tumor in a 5-Year-Old Girl. Case Rep Pediatr 2019; 2019:5427207. [PMID: 31583153 PMCID: PMC6754913 DOI: 10.1155/2019/5427207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/09/2019] [Indexed: 11/26/2022] Open
Abstract
Wilms tumor is the most frequent pediatric renal malignancy, and its usual presentation is an abdominal mass or hematuria. Unusual presentations have also been reported, such as paraneoplastic syndromes (acquired von Willebrand disease, sudden death due to pulmonary embolism, and Cushing syndrome). These conditions can precede, occur concomitantly, or present in a later phase of tumor development. Precocious puberty, as paraneoplastic endocrine syndrome, has already been described in children with malignant tumors (brain, gonadal, adrenal tumors, and hepatoblastoma). However, little is known about central precocious puberty, as paraneoplastic manifestation of nephroblastoma or secondary to its specific chemotherapy. Here, we report a case of Wilms tumor and simultaneous precocious puberty in a 5-year-old girl. The initial diagnosis was premature telarche, but the clinical and biological pubertal progression changed our diagnosis to idiopathic central precocious puberty. Chemotherapy and nephrectomy were well tolerated, and we began treatment with a gonadotropin-releasing hormone agonist which showed favorable outcomes over the short term. We highlight the need for early diagnosis and work-up in all patients of precocious puberty, in order to institute timely management.
Collapse
|
49
|
Karaayvaz S. Clinical Evaluation of Breast in Childhood. Eur J Breast Health 2019; 15:137-140. [PMID: 31312787 DOI: 10.5152/ejbh.2019.4745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 03/18/2019] [Indexed: 12/11/2022]
Abstract
Childhood breast masses are mostly benign conditions starting from the newborn period continuing on to adolescence yet can cause high anxiety in the child and the family as well. As a complaint or physical finding, usually palpable mass, pain or discharge from the nipple is apparent in patients. All the clinicians interested in pediatric field should have full knowledge of immature and developing breasts so to proper diagnose and avoid overtreatment with unnecessary diagnostic or surgical procedures. Though malignancy or life-threatening disease has a very low probability during childhood, all child patients should be evaluated and followed up carefully. Especially training and then encouraging young people to periodically start self-assessment of the breasts after their 19th birthday while warning the ones who have had therapeutic chest radiation previously to begin self-assessment 8 years after the procedure or at 25 years of age whichever comes last, will be an appropriate intervention.
Collapse
Affiliation(s)
- Selda Karaayvaz
- Division of Social Pediatrics, Department of Pediatrics, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| |
Collapse
|
50
|
Abstract
Precocious puberty is defined as the appearance of secondary sex characteristics before 8 years of age in girls and before 9 years of age in boys. Central precocious puberty (CPP) is diagnosed when activation of the hypothalamic-pituitary axis is identified. It is a rare disease with a clear female predominance. A background of international adoption increases its risk, with other environmental factors such as endocrine disruptors also being associated with CPP. The causes of CPP are heterogeneous, with alterations of the CNS being of special interest. Physical injuries of the CNS are more frequent in boys, while idiopathic etiology is more prevalent among girls. However, in the last decade the number of idiopathic cases has diminished thanks to the discovery of mutations in different genes, including KISS1, KISS1R, MKRN3, and DLK1 that cause CPP. For the diagnosis of CPP, hormone studies are needed in addition to the clinical data regarding signs of pubertal onset. For this purpose, the GnRH test continues to be the gold standard. Imaging analyses, such as bone age and brain MRI, are also very useful. Furthermore, genetic testing must be incorporated in the diagnosis of CPP, especially in familial cases. Early puberty has been related to various consequences in the medium and long term such as behavioral problems, breast cancer, obesity, and metabolic comorbidities. However, there are few studies that have exclusively analyzed patients with CPP. GnRH analogs are the most frequent treatment election with the main objective being to improve adult height. Currently, there are new formulations that are being investigated.
Collapse
Affiliation(s)
- Leandro Soriano-Guillén
- Department of Pediatrics, Universidad Autónoma de Madrid, Spain; Department of Pediatrics, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Argente
- Department of Pediatrics, Universidad Autónoma de Madrid, Spain; Department of Pediatrics & Pediatric Endocrinology, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación La Princesa, Madrid, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; IMDEA Food Institute, CEIUAM+CSIC, Madrid, Spain.
| |
Collapse
|