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Huang RH, Yang L, Yang Y, Xu QB, Xie LL, Cao LF. Development and application of a nomogram model for predicting the risk of central precocious puberty in obese girls. Front Pediatr 2024; 12:1421775. [PMID: 39281189 PMCID: PMC11393738 DOI: 10.3389/fped.2024.1421775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/12/2024] [Indexed: 09/18/2024] Open
Abstract
Objective The purpose of this study is to develop and assess a nomogram risk prediction model for central precocious puberty (CPP) in obese girls. Methods We selected 154 cases of obese girls and 765 cases of non-obese girls with precocious puberty (PP) who underwent the gonadotropin-releasing hormone stimulation test at the Jiangxi Provincial Children's Hospital. Univariate analysis and multivariate analysis were conducted to identify predictors of progression to CPP in girls with PP. A predictive model was developed and its predictive ability was preliminarily evaluated. The nomogram was used to represent the risk prediction model for CPP in girls with obesity. The model was validated internally using the Bootstrap method, and its efficacy was assessed using calibration curves and clinical decision analysis curves. Results In obese girls with PP, basal luteinizing hormone (LH) and follicular stimulating hormone (FSH) levels, as well as uterine volume, were identified as independent risk factors for progression to CPP. In non-obese girls, the basal LH level, bone age, and uterine volume were identified as independent risk factors for progression to CPP. With an AUC of 0.896, the risk prediction model for obese girls, was found to be superior to that for non-obese girls, which had an AUC of 0.810. The model displayed strong predictive accuracy. Additionally, a nomogram was used to illustrate the CPP risk prediction model for obese girls. This model performs well in internal validation and is well calibrated, providing a substantial net benefit for clinical use. Conclusion A medical nomogram model of CPP risk in obese girls comprised of basal LH value, basal FSH value, and uterine volume, which can be used to identify those at high risk for progression of CPP in obese girls and develop individualized prevention programs.
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Affiliation(s)
- Ren-Hao Huang
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Li Yang
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
| | - Yu Yang
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
| | - Qing-Bo Xu
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
| | - Li-Ling Xie
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
| | - Lan-Fang Cao
- Department of Endocrinology, Jiangxi Provincial Children's Hosptial/Jiangxi Provincial Clinical Research Center for Children's Genetic Metabolic Diseases, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
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Smets AM, Sofia C, Bruno C, Ključevšek D, Lobo ML, Napolitano M, Ozcan HN, Stafrace S, Petit P, Müller LSO. Abdominal imaging in precocious puberty in girls: can imaging determine onset of puberty? Pediatr Radiol 2024:10.1007/s00247-024-05992-8. [PMID: 39069591 DOI: 10.1007/s00247-024-05992-8] [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: 05/06/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024]
Abstract
Precocious puberty in girls is defined by the appearance of secondary sex characteristics before the age of 8 years. Precocious puberty is either peripheral or central. In most cases, the cause of central precocious puberty is unknown. Rapidly progressive forms of central precocious puberty may benefit from puberty suppression to prevent compromised final height and psychosocial problems related to the physical changes. Idiopathic central precocious puberty in girls can be a challenging diagnosis. Clinical examination, evaluation of growth charts, bone age, and hormonal tests are part of the workup. The role of pelvic ultrasound to evaluate pubertal features of the internal genitalia in this context is controversial. In this paper, we have reviewed the literature to find the scientific bases for several proposed ultrasound parameters and cutoff values for the determination of onset of puberty in girls with suspected central precocious puberty. There are no reliable cutoffs for the measurements of uterus and ovaries for the diagnosis of central precocious puberty and there is overlap in the appearance of the organs in both prepubertal and pubertal girls. The interpretation of the findings on pelvic ultrasound must be done with caution and always in close communication with the referring clinicians.
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Affiliation(s)
- Anne M Smets
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, University of Messina, Messina, Italy
| | - Costanza Bruno
- Radiology Department, AOUI Verona (Azienda Ospedaliera Universitaria Integrata), Verona, Italy
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Maria Luisa Lobo
- Unidade Local de Saúde de Santa Maria (ULSSM, Former CHULN), Av Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - Marcello Napolitano
- Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Milan, Italy
| | - H Nursun Ozcan
- Department of Radiology/Division of Pediatric Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Samuel Stafrace
- McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Philippe Petit
- Department of Pediatric Radiology, Hôpital Timone Enfants, Aix Marseille-Université, Marseille, France
| | - Lil-Sofie Ording Müller
- Division of Radiology and Nuclear Medicine, Department of Paediatric Radiology, Oslo University Hospital, Oslo, Norway
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Breidbart E, Ilkowitz J, Regelmann MO, Ashraf AP, Gourgari E, Kamboj MK, Kohn B, Lahoti A, Mehta S, Miller R, Raman V, Khokhar A, Brar PC. Precocious Puberty and GnRH Analogs: Current Treatment Practices and Perspectives among US Pediatric Endocrinologists. Horm Res Paediatr 2024:1-12. [PMID: 38718766 DOI: 10.1159/000539011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/10/2024] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Gonadotropin releasing hormone analogs (GnRHas) are used for treatment of precocious puberty. Over the last decade, several new formulations have been approved. METHODS The Drugs and Therapeutics Subcommittee of the Pediatric Endocrine Society (PES) undertook a review to ascertain the current treatment options, prescribing behaviors, and practices of GnRHas among pediatric endocrinologists practicing within the USA. The survey consisted of four main subsections: (1) description of clinical practice; (2) self-assessment of knowledge base of pediatric and adult GnRHa formulations; (3) current practice for treating central precocious puberty (CPP); and (4) utilization of healthcare resources. RESULTS There were 223 survey respondents. Pediatric endocrine practitioners were most familiar with the pediatric one-monthly preparation, the 3-month preparation, and the histrelin implant (Supprelin®) (88%, 96%, and 91%, respectively), with lower familiarity for 24-week triptorelin intramuscular (Triptodur®) (65%) and 6-month subcutaneous leuprolide (Fensolvi®) (45%). Only 23% of the respondents reported being extremely familiar with the availability of adult formulations, and 25% reported being completely unaware of cost differences between pediatric and adult GnRHa preparations. The implant was the most preferred therapy (44%), but in practice, respondents reported a higher percentage of patients treated with the 3-month preparation. While family preference/ease of treatment (87%) was the key determinant for using a particular GnRHa preparation, insurance coverage also played a significant role in the decision (64%). Responses regarding assessment for efficacy of treatment were inconsistent, as were practices and criteria for obtaining an MRI. CONCLUSIONS The survey indicated there is more familiarity with older, shorter acting GnRHas, which are prescribed in greater numbers than newer, longer acting formulations. There is lack of consensus on the need for central nervous system (CNS) imaging in girls presenting with CPP between 6 and 8 years of age and use of laboratory testing to monitor response to treatment. Insurance requirements regarding CNS imaging and laboratory monitoring are highly variable. Despite having similar constituents and bioavailability, there are substantial cost differences between the pediatric and adult formulations and lack of evidence for safe use of these formulations in children. The survey-based analysis highlights the challenges faced by prescribers while reflecting on areas where further research is needed to provide evidence-based practice guidelines for pediatric endocrinologists.
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Affiliation(s)
- Emily Breidbart
- Division of Pediatric Endocrinology and Diabetes, NYU School of Medicine, New York, New York, USA
| | - Jeniece Ilkowitz
- Division of Pediatric Endocrinology and Diabetes, NYU School of Medicine, New York, New York, USA
| | - Molly O Regelmann
- Division of Endocrinology and Diabetes, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Ambika P Ashraf
- Division of Pediatric Endocrinology and Diabetes, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Evgenia Gourgari
- Division of Pediatric Endocrinology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Manmohan K Kamboj
- Division of Pediatric Endocrinology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Brenda Kohn
- Division of Pediatric Endocrinology and Diabetes, NYU School of Medicine, New York, New York, USA
| | - Amit Lahoti
- Division of Pediatric Endocrinology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Shilpa Mehta
- Division of Pediatric Endocrinology and Diabetes, New York Medical College, Valhalla, New York, USA
| | - Ryan Miller
- Division of Pediatric Endocrinology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Vandana Raman
- Division of Pediatric Endocrinology, University of Utah, Salt Lake City, Utah, USA
| | - Aditi Khokhar
- Division of Pediatric Endocrinology, Goryeb Children's Hospital, Morristown, New Jersey, USA
| | - Preneet C Brar
- Division of Pediatric Endocrinology and Diabetes, NYU School of Medicine, New York, New York, USA
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Zhu X, Qin J, Xue W, Li S, Zhao M, Yingliang Jin. The effect of GnRH analog treatment on BMI in children treated for precocious puberty: a systematic review and meta-analysis. J Pediatr Endocrinol Metab 2024; 37:297-308. [PMID: 38407229 DOI: 10.1515/jpem-2023-0416] [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: 09/20/2023] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION The purpose of the present meta-analysis was to systematically evaluate the effect of GnRHa treatment on the BMI of children with precocious puberty after GnRHa treatment as compared to before, and to analyze the effect of GnRHa treatment on the body composition of children with precocious puberty at different BMIs by classifying into normal body mass, overweight, and obese groups according to BMI at the time of initial diagnosis. CONTENT A meta-analysis was performed using Stata 12.0 software by searching PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP database), and Wan fang database for relevant literature on standard deviation score of body mass index (BMI-SDS) after GnRHa treatment as compared to before in children with precocious puberty. SUMMARY A total of eight studies were included with a total sample size of 715 cases, and the results of meta-analysis showed that BMI-SDS increased in children with precocious puberty after GnRHa treatment as compared to before starting [(weighted mean difference (WMD)=0.23, 95 % CI: 0.14-0.33, p=0.000)] and also increased in children with normal body mass [(WMD=0.37, 95 % CI: 0.28-0.46, p=0.000)], and there was no significant change in BMI-SDS in children in the overweight or obese group [(WMD=0.01, 95 % CI: -0.08-0.10, p=0.775)]. OUTLOOK Overall, there was an observed increase in BMI-SDS at the conclusion of GnRHa treatment in children with precocious puberty. Additionally, it was found that the effect of GnRHa treatment on body composition varied among children with different BMI status. Clinicians should emphasize the promotion of a healthy lifestyle and personalized dietary management for children.
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Affiliation(s)
- Xiaoxiao Zhu
- Department of Biostatistics, School of Public Health, 38044 Xuzhou Medical University , Xuzhou, Jiangsu, P.R. China
| | - Jiajia Qin
- Department of Biostatistics, School of Public Health, 38044 Xuzhou Medical University , Xuzhou, Jiangsu, P.R. China
| | - Weirong Xue
- Department of Biostatistics, School of Public Health, 38044 Xuzhou Medical University , Xuzhou, Jiangsu, P.R. China
| | - Shengli Li
- Clinical Research Institute, 117910 Affiliated Hospital of Xuzhou Medical University , Xuzhou, Jiangsu, P.R. China
| | - Meng Zhao
- Department of Endocrinology, 117910 Affiliated Hospital of Xuzhou Medical University , Xuzhou, Jiangsu, P.R. China
| | - Yingliang Jin
- Department of Biostatistics, School of Public Health, Center for Medical Statistics and Data Analysis, Key Laboratory of Human Genetics and Environmental Medicine, 38044 Xuzhou Medical University , Xuzhou, Jiangsu, China
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Chen T, Zhang D. Basal gonadotropin levels combine with pelvic ultrasound and pituitary volume: a machine learning diagnostic model of idiopathic central precocious puberty. BMC Pediatr 2023; 23:603. [PMID: 38017451 PMCID: PMC10685612 DOI: 10.1186/s12887-023-04432-0] [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: 08/30/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE The current diagnosis of central precocious puberty (CPP) relies on the gonadotropin-releasing hormone analogue (GnRHa) stimulation test, which requires multiple invasive blood sampling procedures. The aim of this study was to construct machine learning models incorporating basal pubertal hormone levels, pituitary magnetic resonance imaging (MRI), and pelvic ultrasound parameters to predict the response of precocious girls to GnRHa stimulation test. METHODS This retrospective study included 455 girls diagnosed with precocious puberty who underwent transabdominal pelvic ultrasound, brain MRI examinations and GnRHa stimulation testing were retrospectively reviewed. They were randomly assigned to the training or internal validation set in an 8:2 ratio. Four machine learning classifiers were developed to identify girls with CPP, including logistic regression, random forest, light gradient boosting (LightGBM), and eXtreme gradient boosting (XGBoost). The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, area under receiver operating characteristic (AUC) and F1 score of the models were measured. RESULTS The participates were divided into an idiopathic CPP group (n = 263) and a non-CPP group (n = 192). All machine learning classifiers used achieved good performance in distinguishing CPP group and non-CPP group, with the area under the curve (AUC) ranging from 0.72 to 0.81 in validation set. XGBoost had the highest diagnostic efficacy, with sensitivity of 0.81, specificity of 0.72, and F1 score of 0.80. Basal pubertal hormone levels (including luteinizing hormone, follicle-stimulating hormone, and estradiol), averaged ovarian volume, and several uterine parameters were predictors in the model. CONCLUSION The machine learning prediction model we developed has good efficacy for predicting response to GnRHa stimulation tests which could help in the diagnosis of CPP.
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Affiliation(s)
- Tao Chen
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Danbin Zhang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
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Zhou L, Jia X, Yang X. Clinical significance of serum MBD3 detection in girls with central precocious puberty. Open Med (Wars) 2023; 18:20220614. [PMID: 37426049 PMCID: PMC10329158 DOI: 10.1515/med-2022-0614] [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] [Received: 06/14/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 07/11/2023] Open
Abstract
Diagnosis of central precocious puberty (CPP) in girls remains a huge challenge. The current study was to measure the serum expression of methyl-DNA bind protein 3 (MBD3) in CPP girls and assess its diagnostic efficacy. To begin with, we enrolled 109 CPP girls and 74 healthy pre-puberty girls. Then, MBD3 expression in their serum samples was measured via reverse transcription-quantitative polymerase chain reaction, and its diagnostic efficacy on CPP was assessed via the receiver operating characteristic (ROC) curve, followed by correlation analysis between serum MBD3 and patient age, gender, bone age, weight, height, body mass index, basal luteinizing hormone (LH), peak LH, basal follicle-stimulating hormone (FSH), peak FSH, and ovarian size using bivariate correlations method. Finally, independent predictors of MBD3 expression were confirmed using multivariate linear regression analysis. MBD3 was highly expressed in sera of CPP patients. The area under the ROC curve of MBD3 diagnosing CCP was 0.9309, with 1.475 cut-off value (92.66% sensitivity and 86.49% specificity). MBD3 expression positively correlated with basal LH, peak LH, basal FSH, and ovarian size, among which basal LH was considered the strongest independent predictor of MBD3, followed by basal FSH and peak LH. In summary, serum MBD3 could act as a biomarker in aiding CPP diagnosis.
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Affiliation(s)
- Lili Zhou
- Department of Pediatrics, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), No. 1 Dayun Road, Shenzhen, 518000, China
| | - Xiao Jia
- Department of Orthopaedics, Gansu Provincial Hospital of TCM, Lanzhou, 730050, China
| | - Xiangzheng Yang
- Department of Pediatrics, Beijing University of Chinese Medicine Shenzhen Hospital (Longgang), Shenzhen, 518000, China
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Wang W, Cao NN, Xiao Y, Wang Y, Wang YF, Sun J. [Value of basal luteinizing hormone level combined with uterine volume measurement in the early diagnosis of central precocious puberty in girls with different Tanner stages]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:159-165. [PMID: 36854692 PMCID: PMC9979391 DOI: 10.7499/j.issn.1008-8830.2208204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/01/2022] [Indexed: 03/02/2023]
Abstract
OBJECTIVES To study the value of basal luteinizing hormone (LH) level combined with uterine volume measurement in the early diagnosis of central precocious puberty (CPP) in girls with different Tanner stages. METHODS A retrospective analysis was performed on the girls who presented with breast development before the age of 8 years and attended the Third Affiliated Hospital of Zhengzhou University from January 2017 to September 2022. According to the results of gonadotropin-releasing hormone (GnRH) agonist test, the girls with peak LH ≥5.0 IU/L and peak LH/follicle stimulating hormone ≥0.6 were enrolled as the positive group, and the other girls were enrolled as the negative group. The two groups were compared in terms of the basal LH level and uterine volume. The receiver operating characteristic (ROC) curve was used to analyze their value in the early diagnosis of CPP. RESULTS For the girls with Tanner B2 and B3 stages, the positive group had significantly higher basal LH level and uterine volume than the negative group (P<0.05). The basal LH level had an optimal cut-off value of 0.325 IU/L and 0.505 IU/L respectively in the diagnosis of Tanner stage B2/B3 CPP, while uterine volume had an optimal cut-off value of 1.639 mL and 2.158 mL respectively. Basal LH level combined with uterine volume measurement had a significantly larger area under the ROC curve than uterine volume measurement alone (P<0.001), but with no significant difference compared with that of basal LH level measurement alone (P>0.05). CONCLUSIONS Basal LH level combined with uterine volume measurement is valuable in the early diagnosis of CPP in girls with different Tanner stages, which provides a basis and guiding significance for clinical diagnosis of CPP.
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Affiliation(s)
- Wei Wang
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Niu-Niu Cao
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Ya Xiao
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Yan Wang
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Yi-Fan Wang
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
| | - Jun Sun
- Department of Pediatrics, Third Affiliated Hospital of Zhengzhou University/Henan Maternal and Child Health Hospital, Zhengzhou 450052, China
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Mason L, Daskas N. Central precocious puberty: assessment, diagnosis and decisions about treatment. Nurs Child Young People 2023:e1492. [PMID: 38186207 DOI: 10.7748/ncyp.2024.e1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 01/09/2024]
Abstract
Precocious puberty is defined as the onset of puberty before the age of eight years in girls and before the age of nine years in boys. It is associated with negative physical health consequences in the long term and can also have negative psychosocial effects, particularly in adolescence. Central precocious puberty (CPP), which is caused by the early activation of the hypothalamic-pituitary-gonadal axis, is the more prevalent form of precocious puberty. This article explains CPP and its signs, assessment, diagnosis and treatment. It also discusses the factors to consider when deciding whether or not to treat it, stressing the importance of a shared decision-making process that children and parents should be involved in. Precocious puberty must be diagnosed and managed by specialists, but all children's nurses need a broad understanding of the condition so that they can refer children as early as possible and reassure and advise families.
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Affiliation(s)
- Leah Mason
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Nikolaos Daskas
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
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Liu H, Bi Z, Hu Q, Liu S, Dong Z, Wang J. Non-puerperal Uterine Inversion with endometrial polyps in an 11-year-old girl: A Case Report. J Pediatr Adolesc Gynecol 2022; 35:188-191. [PMID: 34610439 DOI: 10.1016/j.jpag.2021.09.007] [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: 07/09/2021] [Revised: 09/06/2021] [Accepted: 09/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Non-puerperal uterine inversion is a rare condition with diagnostic and surgical challenges. Clinically, the inverted uterus appears as a mass protruding from the vagina and is often misdiagnosed as a malignant tumor and surgically removed. CASE An 11-year-old girl was admitted to the emergency room due to spontaneous vaginal mass protrusion. The pudendum examination showed an irregular and dark red neoplasm protruding from the vagina. The final diagnosis was non-puerperal uterine inversion with an endometrial polyp. SUMMARY AND CONCLUSION MRI is the key to the diagnosis of uterine inversion. Our review confirmed that the 11-year-old girl was the youngest in the world to suffer from non-puerperal uterine inversion.
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Affiliation(s)
- Haiping Liu
- Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P.R. China, 330006
| | - Zheng Bi
- Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P.R. China, 330006; Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P.R. China, 330006
| | - Qiwen Hu
- Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P.R. China, 330006; Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, P.R. China, 330006
| | - Shuangxi Liu
- College of Fine Art, Jiangxi Normal University, Nanchang County, Nanchang, Jiangxi, P.R. China, 330022
| | - Zhihua Dong
- Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P.R. China, 330006
| | - Jinhua Wang
- Jiangxi Maternal and Child Health Hospital, Nanchang, Jiangxi, P.R. China, 330006.
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FİDAN N, KENDİRCİ HNP. Evaluation of the efficiency of treatment in girls with central precocious puberty/rapidly progressive puberty via ultrasonography. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1026635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
PURPOSE OF REVIEW In this review, we outline the usage and formulations of gonadotropin-releasing hormone analogs (GnRHas) in central precocious puberty (CPP), short stature, and gender diverse individuals, as well as adverse effects, long-term outcomes, and monitoring of therapy. There is a particular focus on citing references published within the last 24 months. RECENT FINDINGS Long-acting formulations of GnRHa now include Federal Drug Administration approval for subcutaneous injections. Significant adverse events continue to be rarely reported; extremely rare events include arterial hypertension and pseudotumor cerebri. There continue to be no significant long-term consequences including the impact upon body mass index and bone mineral density, which appear to be transient. GnRHas have been used in differences of sexual development (DSD) and increasingly in the treatment of adolescent transgender individuals. SUMMARY GnRHas remain as the only fully efficacious therapy for CPP and effectively suppress pubertal hormones in other situations. The use of GnRHa therapy in gender incongruent individuals has proven beneficial and has become a standard of care, whereas use in those with DSDs should still be considered experimental. VIDEO ABSTRACT http://links.lww.com/MOP/A62.
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Affiliation(s)
- Natalie G Allen
- Division of Endocrinology and Diabetes, Department of Pediatrics, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Yuan B, Pi YL, Zhang YN, Xing P, Chong HM, Zhang HF. A diagnostic model of idiopathic central precocious puberty based on transrectal pelvic ultrasound and basal gonadotropin levels. J Int Med Res 2021; 48:300060520935278. [PMID: 32762408 PMCID: PMC7416140 DOI: 10.1177/0300060520935278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To establish a diagnostic model of idiopathic central precocious puberty on the basis of transrectal pelvic ultrasound and basal gonadotropin. METHODS A total of 669 girls with Tanner breast development stage II were enrolled in this study from January 2015 to December 2018. The participants were divided into the ICPP group and the premature thelarche group. We analyzed various variables, including age at initial diagnosis, basal luteinizing hormone levels, the long diameter of the uterus, the transverse diameter of the uterus, the anterior-posterior diameter of the uterus, the volume of the uterus, maximum ovarian diameter, average ovarian volume, maximum ovarian volume, number of follicles (≥4 mm), maximum follicular diameter, endometrial thickness, and vaginal wall thickness. RESULTS The following diagnostic model was established: Y=-14.123 + 0.630 × age at initial diagnosis + 1.119 × transverse diameter of the uterus + 1.278 × anterior-posterior diameter of the uterus + 0.637 × average ovarian volume + 1.316 × maximum ovarian diameter + 0.146 ×number of follicles ≥4 mm + 2.925 × endometrial thickness + 0.559 × basal luteinizing hormone value. The area under curve was 0.922, sensitivity was 84.9%, and specificity was 86.2%. CONCLUSION Basal LH levels and transrectal pelvic ultrasound should be applied together to improve the accuracy of diagnosis in ICPP.
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Affiliation(s)
- Bo Yuan
- Department of Pediatrics, Affiliated Hospital of Hebei University, Baoding, China
| | - Ya-Lei Pi
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya-Nan Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Peng Xing
- Department of Reproductive Medicine, Baoding Maternal and Child Health Hospital, Baoding, China
| | - He-Meng Chong
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui-Feng Zhang
- Department of Pediatrics, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Yang K, Qi RF, Li RM, Zhang Y, Liu JX. Pelvic Ultrasound Parameters of Long-Acting Depot Formulation of Leuprorelin in the Treatment of Idiopathic Central Precocious Puberty in Girls. Drug Des Devel Ther 2021; 15:1479-1484. [PMID: 33854300 PMCID: PMC8039020 DOI: 10.2147/dddt.s298155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The present study was designed to compare the changes in ovarian and uterine parameters in girls with idiopathic central precocious puberty (ICPP) before and after gonadotropin-releasing hormone analogues (GnRHa) treatment to determine which sensitive indexes effectively reflect the therapeutic effect. METHODS Sixty girls diagnosed with ICPP were enrolled in the present study. Relevant data were recorded before treatment. Leuprorelin acetate microspheres were injected at a dose of 30-180 μg/(kg four weeks). Relevant parameters were measured and recorded every three months. Changes in each parameter were analyzed to evaluate the clinical effect of leuprorelin in the treatment of girls with ICPP. RESULTS 1) The height grew at a constant rate. 2) The breasts retracted. 3) Changes in pelvic parameters: the volume of the ovary and uterus and major axes of the ovary, uterus, and cervix were reduced; there were no significant changes in vaginal thickness or the uterine fundal-cervical ratio (FCR). 4) Body mass index (BMI) increased. CONCLUSION Pelvic ultrasound is helpful in evaluating the efficacy of GnRHA treatment. The changes of ovarian volume and the major axes of the ovary, uterus, cervix can be used as sensitive observation indexes.
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Affiliation(s)
- Kun Yang
- Child Health Care Department, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
| | - Rui-Fang Qi
- Endocrinology Department, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
| | - Rong-Min Li
- Endocrinology Department, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
| | - Yu Zhang
- Department of Science and Education, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
| | - Jing-Xia Liu
- Child Health Care Department, Baoding Children’s Hospital, Baoding, 071000, Hebei Province, People’s Republic of China
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Calcaterra V, Klersy C, Vinci F, Regalbuto C, Dobbiani G, Montalbano C, Pelizzo G, Albertini R, Larizza D. Rapid progressive central precocious puberty: diagnostic and predictive value of basal sex hormone levels and pelvic ultrasound. J Pediatr Endocrinol Metab 2020; 33:785-791. [PMID: 32441670 DOI: 10.1515/jpem-2019-0577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/23/2020] [Indexed: 11/15/2022]
Abstract
Objectives Data on the predictive values of parameters included in the diagnostic work-up for precocious puberty (PP) remain limited. We detected the diagnostic value of basal sex hormone levels, pelvic ultrasound parameters and bone age assessment for activation of the hypothalamic-pituitary-gonadal axis in girls with PP, in order to help in the decision to perform GnRH testing. Patients and methods We retrospectively considered 177 girls with PP. According to puberty evolution, the girls were divided into two groups: rapid progressive central precocious puberty (RP-CPP) and non/slowly progressive/transient forms (SP-PP). In all patients we considered Tanner stage, basal luteinizing hormone (LH) and estradiol (E2) values, bone age, and pelvis examination. We assessed the diagnostic value of each variable and identified the number of pathological parameters that best identify patients with RP-CPP. Results Basal LH ≥ 0.2IU/L, E2 level ≥ 50 pmol/L, uterine longitudinal diameter ≥ 3.5 cm, transverse uterine diameter ≥ 1.5 cm, endometrial echo and ovarian volume ≥ 2 cm3 were significantly associated with RP-CPP (p ≤ 0.01). The ability to diagnose RP-CPP was enhanced with increasing number of pathological hormonal and instrumental parameters (p < 0.001). With more than three parameters detected, sensitivity and specificity reached 58% (95%CI 48-67) and 85% (95%CI 74-92), respectively, with a PPV = 86% (95%CI 76-93) and PPN = 54% (95%CI 43-54); the area under the ROC curve was 0.71 (95%CI 0.65-0.78). Conclusion Despite the availability of different tests, diagnosing RP-CPP remains difficult. A diagnosis model including at least three hormonal and/or ultrasound parameters may serve as a useful preliminary step in selecting patients who require GnRH testing for early detection of RC-PP.
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Affiliation(s)
- Valeria Calcaterra
- Department of Maternal and Children's Health, Pediatric Endocinology Unit, Fondazione IRCCS Policlinico S. Matteo and University of Pavia, P.le Golgi n.2, 27100, Pavia, Italy
- Department of Internal Medicine, Pediatric and Adolescent Unit, University of Pavia, Pavia, Italy
| | - Catherine Klersy
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Vinci
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Corrado Regalbuto
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giulia Dobbiani
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Montalbano
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gloria Pelizzo
- Pediatric Surgery Unit, Ospedale dei Bambini "Vittore Buzzi" and Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Milano, Italy
| | - Riccardo Albertini
- Laboratory of Clinical Chemistry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Larizza
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children's Health, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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