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Etiological, clinical and biochemical characteristics of 367 children with early pubertal development from the Trakya region of Turkey

Yıl 2022, Cilt: 47 Sayı: 4, 1412 - 1423, 28.12.2022
https://doi.org/10.17826/cumj.1176227

Öz

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<0,05). It is impossible for the laboratory results to exactly match in each case with CPP, and the cases should be evaluated along with other clinical findings.

Conclusion: We detected an increase in the frequency of girls referred with PP signs in our study. The majority of children with PP were revealed as an incomplete type with a very low incidence of endocrine pathology. The complexity of pathogenesis in PP should lead us to be cautious about the consequences of PP in patients and evaluate their complaints, physical findings, and laboratory work-up seriously, such as a piece of a puzzle.

Kaynakça

  • 1. Berberoğlu M: Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. Journal of clinical research in pediatric endocrinology 2009; 1(4):164.
  • 2. 2. Kaplowitz P, Bloch C, Section on Endocrinology AAoP: Evaluation and Referral of Children With Signs of Early Puberty. Pediatrics 2016; 137(1).
  • 3. 3. Partsch C-J, Sippell WG: Pathogenesis and epidemiology of precocious puberty. Effects of exogenous oestrogens. Human reproduction update 2001; 7(3):292-302.
  • 4. 4. Slyper AH: The pubertal timing controversy in the USA, and a review of possible causative factors for the advance in timing of onset of puberty. Clinical endocrinology 2006; 65(1):1-8.
  • 5. 5. Marshall WA, Tanner JM: Variations in pattern of pubertal changes in girls. Archives of disease in childhood 1969; 44(235):291.
  • 6. 6. Della Manna T, Setian N, Damiani D, Kuperman H, Dichtchekenian V: Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty. Rev Hosp Clin Fac Med Sao Paulo 2002; 57(2):49-54.
  • 7. 7. Cole T: A chart to link child centiles of body mass index, weight and height. European Journal of Clinical Nutrition 2002; 56(12):1194.
  • 8. 8. Taher B, Ajlouni H, Hamamy H, Shegem N, Madanat A, Ajlouni K: Precocious puberty at an endocrine centre in Jordan. European journal of clinical investigation 2004;34(9):599-604.
  • 9. 9. Kaplowitz P: Clinical characteristics of 104 children referred for evaluation of precocious puberty. The Journal of Clinical Endocrinology & Metabolism 2004; 89(8):3644-3650.
  • 10. 10. Pasquino A, Tebaldi L, Cioschi L, Cives C, Finocchi G, Maciocci M, Mancuso G, Boscherini B: Premature thelarche: a follow up study of 40 girls. Natural history and endocrine findings. Archives of disease in childhood 1985; 60(12):1180-1182.
  • 11. 11. Pasquino A, Piccolo F, Scalamandre A, Malvaso M, Ortolani R, Boscherini B: Hypothalamic-pituitary-gonadotropic function in girls with premature thelarche. Archives of disease in childhood 1980; 55(12):941-944.
  • 12. 12. Mogensen SS, Aksglaede L, Mouritsen A, Sørensen K, Main KM, Gideon P, Juul A: Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. The Journal of Clinical Endocrinology & Metabolism 2011; 96(5):1393-1401.
  • 13. 13. Soriano-Guillén L, Corripio R, Labarta JI, Cañete R, Castro-Feijóo L, Espino R, Argente J: Central precocious puberty in children living in Spain: incidence, prevalence, and influence of adoption and immigration. The Journal of Clinical Endocrinology & Metabolism 2010; 95(9):4305-4313.
  • 14. 14. de Vries L, Horev G, Schwartz M, Phillip M: Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. European Journal of Endocrinology 2006; 154(6):891-898.
  • 15. 15. Partsch CJ, Heger S, Sippell WG: Management and outcome of central precocious puberty. Clinical endocrinology 2002; 56(2):129-148.
  • 16. 16. Cisternino M, Arrigo T, Pasquino AM, Tinelli C, Antoniazzi F, Beduschi L, Bindi G, Borrelli P, De Sanctis V, Farello G: Etiology and age incidence of precocious puberty in girls: a multicentric study. Journal of Pediatric Endocrinology and Metabolism 2000, 13(Supplement):695-702.
  • 17. 17. Crofton P, Evans A, Groome N, Taylor M, Holland C, Kelnar C: Dimeric inhibins in girls from birth to adulthood: relationship with age, pubertal stage, FSH and oestradiol. Clinical endocrinology 2002; 56(2):223-230.
  • 18. 18. Solorzano CMB, McCartney CR: Obesity and the pubertal transition in girls and boys. Reproduction 2010; 140(3):399-410.
  • 19. 19. Kaplowitz PB: Link between body fat and the timing of puberty. Pediatrics 2008, 121(Supplement 3):S208-S217.
  • 20. 20. Aksglaede L, Juul A, Olsen LW, Sørensen TI: Age at puberty and the emerging obesity epidemic. PloS one 2009; 4(12):e8450.
  • 21. 21. Ebling FJ: The neuroendocrine timing of puberty. Reproduction 2005, 129(6):675-683.
  • 22. 22. Ying Y, Tang J, Chen W, Cai Z, Niu WT: GnRH agonist treatment for idiopathic central precocious puberty can improve final adult height in Chinese girls. Oncotarget 2017; 8(65):109061.
  • 23. 23. Harrington J, Palmert MR, Hamilton J: Use of local data to enhance uptake of published recommendations: an example from the diagnostic evaluation of precocious puberty. Archives of disease in childhood 2013:archdischild-2013-304414.
  • 24. 24. Carretto F, Salinas-Vert I, Granada-Yvern M, Murillo-Vallés M, Gómez-Gómez C, Puig-Domingo M, Bel J: The usefulness of the leuprolide stimulation test as a diagnostic method of idiopathic central precocious puberty in girls. Hormone and Metabolic Research 2014; 46(13):959-963.
  • 25. 25. Brito VN, Latronico AC, Arnhold IJ, Mendonça BB: Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arquivos Brasileiros de Endocrinologia & Metabologia 2008;52(1):18-31.
  • 26. 26. Zou CC, Liang L, Dong GP, Zhao ZY: Peripheral precocious puberty: a retrospective study for six years in Hangzhou, China. Journal of paediatrics and child health 2008, 44(7‐8):415-418.
  • 27. 27. Armengaud J-B, Charkaluk M-L, Trivin C, Tardy V, Bréart G, Brauner R, Chalumeau M: Precocious pubarche: distinguishing late-onset congenital adrenal hyperplasia from premature adrenarche. The Journal of Clinical Endocrinology & Metabolism 2009; 94(8):2835-2840.
  • 28. 28. Sontag-Padilla LM, Dorn LD, Tissot A, Susman EJ, Beers SR, Rose SR: Executive functioning, cortisol reactivity, and symptoms of psychopathology in girls with premature adrenarche. Dev Psychopathol 2012;24(1):211-223.
  • 29. 29. Forest MG: Recent advances in the diagnosis and management of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Human Reproduction Update 2004; 10(6):469-485.
  • 30. 30. Sopher AB, Thornton JC, Silfen ME, Manibo A, Oberfield SE, Wang J, Pierson Jr RN, Levine LS, Horlick M: Prepubertal girls with premature adrenarche have greater bone mineral content and density than controls. The Journal of Clinical Endocrinology & Metabolism 2001; 86(11):5269-5272.

Türkiye’nin Trakya bölgesinde erken prepubertal gelişim ile takip edilen 367 çocuğun biyokimyasal klinik ve etiyolojik özellikleri

Yıl 2022, Cilt: 47 Sayı: 4, 1412 - 1423, 28.12.2022
https://doi.org/10.17826/cumj.1176227

Öz

Amaç: Menarşın dokuz yaşından önce ortaya çıkması, ikincil cinsiyet özelliklerinin kızlarda 8, erkeklerde 9 yaşından önce görülmesi Erken Puberte (EP) olarak tanımlanır. Bu çalışmanın amacı, EP'li çocukların etiyolojilerini, klinik bulgularını tanımlamak ve antropometrik özellikleri ile biyokimyasal özelliklerini karşılaştırmaktır.
Yöntem: Bu tek merkezli çalışmada tıbbi kayıtları incelenen 367 hastaya erken telarş (ET), erken adrenarş (EA), gerçek erken puberte (GEP) ve Periferik Erken Puberte (PEP) tanıları kondu. Tanı klinik, laboratuvar, radyolojik incelemeler ve bunların takibine dayanıyordu.
Bulgular: Altı yıl içinde 349 kız (%95,1) ve 18 erkek (%4,9) EP tanısı aldı. En sık etiyoloji sırasıyla GEP;127 (%34,6), ET;117 (%31,9), EA;112(%30,5) ve PEP 11(%3) idi. GEP grubunda boy, kilo, vücut kitle indeksi (BMI) ve obezite/fazla kilolu insidansı, östradiol (E2), bazal lüteinize edici hormon (LH), pik LH ve pik LH/FSH oranı anlamlı olarak daha yüksekti ve ET grubuna göre uterus boyutları daha yüksekken, ET grubu GEP grubuna göre anlamlı olarak daha yüksek pik FSH seviyelerine sahipti (p<0,05). Her olguda laboratuvar sonuçlarının GEP ile tam olarak eşleşmesi mümkün değildir ve olgular diğer klinik bulgularla birlikte değerlendirilmelidir.
Sonuç: Çalışmamızda EP bulguları ile başvuran kızların sıklığında artış saptadık. EP'li çocukların çoğu, endokrin patoloji insidansı çok düşük olan inkomplet tip olarak ortaya çıktı. EP'deki patogenez oldukça karmaşıktır ve EP tanılı hasta sonuçları konusunda dikkatli olunmalı ve şikayet, fizik muayene ve laboratuvar bulguları yapbozun bir parçası olarak ciddi bir şekilde değerlendirilmelidir.

Kaynakça

  • 1. Berberoğlu M: Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. Journal of clinical research in pediatric endocrinology 2009; 1(4):164.
  • 2. 2. Kaplowitz P, Bloch C, Section on Endocrinology AAoP: Evaluation and Referral of Children With Signs of Early Puberty. Pediatrics 2016; 137(1).
  • 3. 3. Partsch C-J, Sippell WG: Pathogenesis and epidemiology of precocious puberty. Effects of exogenous oestrogens. Human reproduction update 2001; 7(3):292-302.
  • 4. 4. Slyper AH: The pubertal timing controversy in the USA, and a review of possible causative factors for the advance in timing of onset of puberty. Clinical endocrinology 2006; 65(1):1-8.
  • 5. 5. Marshall WA, Tanner JM: Variations in pattern of pubertal changes in girls. Archives of disease in childhood 1969; 44(235):291.
  • 6. 6. Della Manna T, Setian N, Damiani D, Kuperman H, Dichtchekenian V: Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty. Rev Hosp Clin Fac Med Sao Paulo 2002; 57(2):49-54.
  • 7. 7. Cole T: A chart to link child centiles of body mass index, weight and height. European Journal of Clinical Nutrition 2002; 56(12):1194.
  • 8. 8. Taher B, Ajlouni H, Hamamy H, Shegem N, Madanat A, Ajlouni K: Precocious puberty at an endocrine centre in Jordan. European journal of clinical investigation 2004;34(9):599-604.
  • 9. 9. Kaplowitz P: Clinical characteristics of 104 children referred for evaluation of precocious puberty. The Journal of Clinical Endocrinology & Metabolism 2004; 89(8):3644-3650.
  • 10. 10. Pasquino A, Tebaldi L, Cioschi L, Cives C, Finocchi G, Maciocci M, Mancuso G, Boscherini B: Premature thelarche: a follow up study of 40 girls. Natural history and endocrine findings. Archives of disease in childhood 1985; 60(12):1180-1182.
  • 11. 11. Pasquino A, Piccolo F, Scalamandre A, Malvaso M, Ortolani R, Boscherini B: Hypothalamic-pituitary-gonadotropic function in girls with premature thelarche. Archives of disease in childhood 1980; 55(12):941-944.
  • 12. 12. Mogensen SS, Aksglaede L, Mouritsen A, Sørensen K, Main KM, Gideon P, Juul A: Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. The Journal of Clinical Endocrinology & Metabolism 2011; 96(5):1393-1401.
  • 13. 13. Soriano-Guillén L, Corripio R, Labarta JI, Cañete R, Castro-Feijóo L, Espino R, Argente J: Central precocious puberty in children living in Spain: incidence, prevalence, and influence of adoption and immigration. The Journal of Clinical Endocrinology & Metabolism 2010; 95(9):4305-4313.
  • 14. 14. de Vries L, Horev G, Schwartz M, Phillip M: Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. European Journal of Endocrinology 2006; 154(6):891-898.
  • 15. 15. Partsch CJ, Heger S, Sippell WG: Management and outcome of central precocious puberty. Clinical endocrinology 2002; 56(2):129-148.
  • 16. 16. Cisternino M, Arrigo T, Pasquino AM, Tinelli C, Antoniazzi F, Beduschi L, Bindi G, Borrelli P, De Sanctis V, Farello G: Etiology and age incidence of precocious puberty in girls: a multicentric study. Journal of Pediatric Endocrinology and Metabolism 2000, 13(Supplement):695-702.
  • 17. 17. Crofton P, Evans A, Groome N, Taylor M, Holland C, Kelnar C: Dimeric inhibins in girls from birth to adulthood: relationship with age, pubertal stage, FSH and oestradiol. Clinical endocrinology 2002; 56(2):223-230.
  • 18. 18. Solorzano CMB, McCartney CR: Obesity and the pubertal transition in girls and boys. Reproduction 2010; 140(3):399-410.
  • 19. 19. Kaplowitz PB: Link between body fat and the timing of puberty. Pediatrics 2008, 121(Supplement 3):S208-S217.
  • 20. 20. Aksglaede L, Juul A, Olsen LW, Sørensen TI: Age at puberty and the emerging obesity epidemic. PloS one 2009; 4(12):e8450.
  • 21. 21. Ebling FJ: The neuroendocrine timing of puberty. Reproduction 2005, 129(6):675-683.
  • 22. 22. Ying Y, Tang J, Chen W, Cai Z, Niu WT: GnRH agonist treatment for idiopathic central precocious puberty can improve final adult height in Chinese girls. Oncotarget 2017; 8(65):109061.
  • 23. 23. Harrington J, Palmert MR, Hamilton J: Use of local data to enhance uptake of published recommendations: an example from the diagnostic evaluation of precocious puberty. Archives of disease in childhood 2013:archdischild-2013-304414.
  • 24. 24. Carretto F, Salinas-Vert I, Granada-Yvern M, Murillo-Vallés M, Gómez-Gómez C, Puig-Domingo M, Bel J: The usefulness of the leuprolide stimulation test as a diagnostic method of idiopathic central precocious puberty in girls. Hormone and Metabolic Research 2014; 46(13):959-963.
  • 25. 25. Brito VN, Latronico AC, Arnhold IJ, Mendonça BB: Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arquivos Brasileiros de Endocrinologia & Metabologia 2008;52(1):18-31.
  • 26. 26. Zou CC, Liang L, Dong GP, Zhao ZY: Peripheral precocious puberty: a retrospective study for six years in Hangzhou, China. Journal of paediatrics and child health 2008, 44(7‐8):415-418.
  • 27. 27. Armengaud J-B, Charkaluk M-L, Trivin C, Tardy V, Bréart G, Brauner R, Chalumeau M: Precocious pubarche: distinguishing late-onset congenital adrenal hyperplasia from premature adrenarche. The Journal of Clinical Endocrinology & Metabolism 2009; 94(8):2835-2840.
  • 28. 28. Sontag-Padilla LM, Dorn LD, Tissot A, Susman EJ, Beers SR, Rose SR: Executive functioning, cortisol reactivity, and symptoms of psychopathology in girls with premature adrenarche. Dev Psychopathol 2012;24(1):211-223.
  • 29. 29. Forest MG: Recent advances in the diagnosis and management of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Human Reproduction Update 2004; 10(6):469-485.
  • 30. 30. Sopher AB, Thornton JC, Silfen ME, Manibo A, Oberfield SE, Wang J, Pierson Jr RN, Levine LS, Horlick M: Prepubertal girls with premature adrenarche have greater bone mineral content and density than controls. The Journal of Clinical Endocrinology & Metabolism 2001; 86(11):5269-5272.
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma
Yazarlar

Sebile Kılavuz 0000-0002-7527-2620

Diğdem Bezen 0000-0003-3977-5527

Necdet Süt 0000-0001-6678-482X

Emine Dilek 0000-0003-4016-001X

Filiz Tütüncüler 0000-0003-3710-288X

Yayımlanma Tarihi 28 Aralık 2022
Kabul Tarihi 28 Eylül 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 47 Sayı: 4

Kaynak Göster

MLA Kılavuz, Sebile vd. “Etiological, Clinical and Biochemical Characteristics of 367 Children With Early Pubertal Development from the Trakya Region of Turkey”. Cukurova Medical Journal, c. 47, sy. 4, 2022, ss. 1412-23, doi:10.17826/cumj.1176227.