Self-assessment of pubertal development in a puberty cohort

2018 ◽  
Vol 31 (7) ◽  
pp. 763-772 ◽  
Author(s):  
Andreas Ernst ◽  
Lea Lykke B. Lauridsen ◽  
Nis Brix ◽  
Camilla Kjersgaard ◽  
Jørn Olsen ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Weighted Kappa ◽  
Pubic Hair ◽  
Kappa Statistics ◽  
Random Errors ◽  
Rater Agreement ◽  
Self Assessment ◽  
Tanner Staging

Abstract Background We evaluated the inter-rater agreement between self-assessed Tanner staging and clinical examination and the intra-individual agreement of self-assessed information on various puberty markers in late adolescents from the longitudinal nationwide Puberty Cohort, a sub-cohort of the Danish National Birth Cohort (DNBC). Methods We invited 715 children from the ongoing Puberty Cohort between June 2016 and January 2017. In total, 366 children (51%) returned an add-on questionnaire identical to the questionnaire used to collect information on puberty markers, including Tanner staging, in the Puberty Cohort. Of these, 197 (54%) also participated in a clinical examination with Tanner staging. We used percentage agreement and weighted kappa statistics to evaluate the inter-rater and intra-individual agreement. Results Due to late entry, more than 75% of children were Tanner stage 4 or above at clinical examination. In girls, the inter-rater agreement for pubic hair and breast staging was 54% and 52%, respectively, yielding weighted kappas of fair strength. In boys, pubic hair and genital staging agreed in 55% and 33%, respectively, corresponding to weighted kappas of fair to moderate strength. Boys tended to underestimate genitalia staging consistently. The intra-individual agreement on Tanner staging was 75–77% in girls and 69% in boys, whereas the intra-individual agreement on axillary hair and acne was above 92%. Conclusions Self-assessment of late stages of pubertal development may be misclassified, leading to random errors in studies of puberty timing. However, self-assessment continues to serve as an important time- and cost-saving tool in large prospective puberty cohorts.

Can we rely on adolescents to self-assess puberty stage? A systematic review and meta-analysis

2020 ◽  
Vol 105 (8) ◽  
pp. 2846-2856 ◽  
Author(s):  
Susan C Campisi ◽  
Josée D Marchand ◽  
Fahad Javaid Siddiqui ◽  
Muhammad Islam ◽  
Zulfiqar A Bhutta ◽  
...  
Keyword(s):  
Data Extraction ◽  
Meta Analysis ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Pubic Hair ◽  
Cochrane Library ◽  
Self Assessment ◽  
Pubertal Stage ◽  
Tanner Staging ◽  
Stage 1

Abstract Context Clinicians, researchers, and global health advocates often include pubertal development in outcomes. However, assessments of pubertal stage can be challenging because of the sensitive nature and feasibility of clinical examinations, especially in larger settings. Objective To determine the accuracy of self-assessed Tanner staging when compared with physically assessed Tanner stages by a clinician. Data Sources MEDLINE, PubMed, Embase, Web of Science, Scopus, the Cochrane Library, CINAHL. Study Selection Studies were included if they reported 5 × 5 tables of self-assessment compared to clinician–assessment for the 5-stage Tanner scale. Data Extraction We extracted data to generate complete 5 × 5 tables for each study, including any subgroup eligible for the analysis, such as overweight/obese youth. Data Synthesis After screening, 22 studies representing 21,801 participants met our inclusion criteria for the meta-analysis. Overall agreement was moderate or substantial between the 2 assessments, with breast stage 1, female pubic hair 1, male pubic hair 1, and male pubic hair 5 having the highest agreement. When stages were collapsed into pre- (Tanner stage 1), in (stages 2,3), and completing (stages 4,5) puberty, levels of agreement improved, especially for pre- and completing pubertal development. Most included studies comprised Caucasian youth. More studies are needed which include a broader range of geographic and socioeconomic settings, as well as a greater diversity of racial/ethnic groups. Conclusions Self-assessment of puberty is most accurate when identifying Tanner stage 1, Tanner stage 5 and when development is categorized into prepuberty, in, and completing puberty phases. Use of self-assessment data should be structured accordingly. Protocol Registration PROSPERO # CRD42018100205

scholarly journals Urinary and salivary endocrine measurements to complement Tanner staging in studies of pubertal development

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251598
Author(s):  
Mandy Goldberg ◽  
Anna J. Ciesielski Jones ◽  
John A. McGrath ◽  
Christie Barker-Cummings ◽  
Deborah S. Cousins ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Pubic Hair ◽  
Health Study ◽  
Final Visit ◽  
Tanner Staging ◽  
Non Invasive ◽  
Stage 1

Background Many studies investigating pubertal development use Tanner staging to assess maturation. Endocrine markers in urine and saliva may provide an objective, sensitive, and non-invasive method for assessing development. Objective Our objective was to examine whether changes in endocrine levels can indicate the onset of pubertal development prior to changes in self-rated Tanner stage. Methods Thirty-five girls and 42 boys aged 7 to 15 years were enrolled in the Growth and Puberty (GAP) study, a longitudinal pilot study conducted from 2007–2009 involving children of women enrolled in the Agricultural Health Study (AHS) in Iowa. We collected saliva and urine samples and assessed pubertal development by self-rated Tanner staging (pubic hair, breast development (girls), genital development (boys)) at three visits over six months. We measured dehydroepiandrosterone (DHEA) in saliva and creatinine-adjusted luteinizing hormone (LH), testosterone, follicle stimulating hormone (FSH), estrone 3-glucuronide (E13G) and pregnanediol 3-glucuronide (Pd3G) concentrations in first morning urine. We evaluated the relationships over time between Tanner stage and each biomarker using repeated measures analysis. Results Among girls still reporting Tanner breast stage 1 at the final visit, FSH levels increased over the 6-month follow-up period and were no longer lower than higher stage girls at the end of follow-up. We observed a similar pattern for testosterone in boys. By visit 3, boys still reporting Tanner genital stage 1 or pubic hair stage 1 had attained DHEA levels that were comparable to those among boys reporting Tanner stages 2 or 3. Conclusions Increasing concentrations of FSH in girls and DHEA and testosterone in boys over a 6-month period revealed the start of the pubertal process prior to changes in self-rated Tanner stage. Repeated, non-invasive endocrine measures may complement the more subjective assessment of physical markers in studies determining pubertal onset.

scholarly journals Assessment of mean testicular volume in adolescent school boys of Udaipur district in 10 to 18 years at different stages of pubertal development

2020 ◽  
Vol 7 (4) ◽  
pp. 871
Author(s):  
Tarun Babani ◽  
Devendra Sareen ◽  
Dileep Goyal
Keyword(s):  
Pubertal Development ◽  
Accurate Method ◽  
Pubic Hair ◽  
Testicular Volume ◽  
Major Surgery ◽  
Age Group ◽  
Tanner Staging ◽  
Secondary Sexual Characters ◽  
Early Rise ◽  
Secondary Sexual

Background: The most obvious and important changes during puberty are secondary sexual characters. To check the correlation between testicular volumes with secondary sexual characters, nutritional status in Udaipur schoolboy’s assessment of testicular volume by prayer orchidometer is easy and reliable and accurate method in community. Aim of the study was to find out mean testicular volume by prader orchidometer at different stages of pubertal development.Methods: Children between 10 to 18 years of age (525 in numbers) from schools of Udaipur city were included. Children thoroughly examined for presence of any systemic disorders or major surgery was excluded. Informed consent with parents was taken Testicular volume assessment done by praders orchidometer with Tanner staging and correlation was statically analysed.Results: Maximum boys belonged to 15-16 years of age group (14.7%), and minimum belongs to 10-11 years age group (9.3%). Secondary sexual characters increases as mean testicular volume increases. The mean testicular volume for P1 (4.46 ml) and P5 (22.68 ml) and G1 (4.69 ml) and G5 (23.27 ml) with a p<0.05.Conclusions: Testicular volume adds more objectivity in SMR detection and helps to differentiate early genital maturation than pubic hair. Study population had early rise of testicular volume before pubic hair clinically visible which shows that testicular volume is the first to increase with the onset of puberty.

scholarly journals Comparison of Clinical, Ultrasonographic, and Biochemical Differences at the Beginning of Puberty in Healthy Girls Born Either Small for Gestational Age or Appropriate for Gestational Age: Preliminary Results

2006 ◽  
Vol 91 (9) ◽  
pp. 3377-3381 ◽  
Author(s):  
M. I. Hernández ◽  
A. Martínez ◽  
T. Capurro ◽  
V. Peña ◽  
L. Trejo ◽  
...  
Keyword(s):  
Gestational Age ◽  
Small For Gestational Age ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Bone Age ◽  
Dehydroepiandrosterone Sulfate ◽  
Early Morning ◽  
Pubic Hair ◽  
Ultrasound Measurements ◽  
Appropriate For Gestational Age

Abstract Context: There are limited and controversial data concerning puberty characteristics in girls born small for gestational age (SGA). Objective: The objective of the study was to document clinical, ultrasonographic, and biochemical characteristics at the beginning of puberty in matched healthy girls born either SGA or appropriate for gestational age (AGA) recruited from the community. Patients: Inclusion criteria were breast Tanner stage II and a body mass index between the 10th and 95th percentiles. Interventions: Recruited subjects underwent a complete physical exam, bone age, and ultrasound measurements of the internal genitalia. Hormonal assessment included fasting early morning dehydroepiandrosterone sulfate, androstenedione, SHBG, inhibin-B, FSH, LH, estradiol (E2), 17-hydroxyprogesterone (17OH Prog), and testosterone. Thereafter, a GnRH agonist test (leuprolide 500 μg, sc) was performed with FSH and LH at time 3 and 24 h for E2, 17OH Prog, and testosterone. Results: Sixty-five girls (35 AGA, 30 SGA) with a mean age of 9.9 ± 1.03 (7.8–12.5) yr, similar bone age/chronological age (1.02 ± 0.8 in AGA and 1 ± 0.76 in SGA), median height of 1.35 ± 0.06 cm, and similar waist to hip ratio were included. No differences in the presence of pubic hair, axillary hair, apocrine odor, or ultrasound measurements were found. SGA girls had increased baseline E2 as well as stimulated E2 and 17OH Prog. Conclusions: In a preliminary sample of lean, healthy girls recruited from the community born either SGA or AGA, we observed slight hormonal differences at the beginning of puberty. Longitudinal follow-up of this cohort will allow us to understand whether these differences are maintained and have a clinical impact in their pubertal development.

Pubertal assessment: targeted educational intervention for pediatric trainees

2017 ◽  
Vol 31 (6) ◽  
Author(s):  
Aditi Khokhar ◽  
Sairaman Nagarajan ◽  
Yagnaram Ravichandran ◽  
Sheila Perez-Colon
Keyword(s):  
Educational Intervention ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Clinical Practices ◽  
Post Intervention ◽  
Tanner Staging ◽  
Confidence Levels ◽  
Comfort Levels ◽  
Pediatric Residency ◽  
Baseline Knowledge

Abstract Background Timely and periodic pubertal assessment in children is vital to identify puberty related disorders. Pediatricians need to have working knowledge of puberty time and tempo. Pediatric residency is an important platform to acquire physical examination skills including pubertal assessment. Objective An educational intervention for teaching pubertal assessment was piloted on pediatric residents at our institution. Methods The intervention comprised of interactive lecture series, ID badge size Tanner stage cards and Tanner posters placed in residents’ continuity clinics. Pre-intervention, post-intervention and 3 months post-intervention surveys for participating trainees were administered to determine the effectiveness of the intervention. Attitudes, practices, knowledge scores, and barriers to Tanner staging conduct were analyzed. Results Forty-three residents participated in the intervention. Knowledge scores of PGY1 (5.95 ± 1.6 vs. 7.47 ± 1.4, p < 0.01) improved right after the intervention, as did self-reported clinical practices of all trainees 3 months post- intervention with regards to conducting external genital examination and performing pubertal assessment. Confidence levels of pediatric trainees in conducting pubertal assessment and comfort levels in assessing the need for endocrine referral based on abnormal Tanner staging improved after the intervention, although the effect was not statistically significant. Conclusion Our intervention is a worthwhile technique for teaching pubertal assessment to residents as it is simple to conduct, easily reproducible, provides baseline knowledge needed for recognition of normal pubertal development and puberty related conditions, and instills confidence in residents.

scholarly journals Obesity and secondary sexual maturity in boys

2016 ◽  
Vol 53 (5) ◽  
pp. 283
Author(s):  
Modella Rahmani Femina ◽  
Madarina Julia ◽  
Soeroyo Machfudz
Keyword(s):  
Sexual Maturity ◽  
Tanner Stage ◽  
Pubic Hair ◽  
Testicular Volume ◽  
Growth Charts ◽  
Pediatric Resident ◽  
Tanner Staging ◽  
Prepubertal Boys ◽  
The Mean ◽  
Secondary Sexual

Background Obesity induces earlier secondary sexual maturity in girls. However, results of studies in boys have been inconclusive.Objective To assess for an association between obesity and sexual maturity in boys.Methods This was a prospective cohort study on 133 obese and 133 matched-for-age, non-obese, prepubertal boys, aged 9 to 10 years. They were observed every 4 months for a two year period. Obesity was defined as the BMI ≥the 95th percentile, according to the Centers for Disease Control 2000 growth charts. Secondary sexual maturity was defined as testicular volume of ≥4 mL and Tanner staging of pubic hair of ≥P2. Two trained nurses and a pediatric resident collected the data.Results By the end of the study period, 106 (79.7%) obese boys had attained a testicular volume of 4 mL or more, vs. 85 (63.9%) non-obese boys (RR 1.78; 95%CI 1.19 to 2.67; P=0.004). Furthermore, 81 (60.9%) obese boys attained pubic hair states of Tanner stage P2 vs. 37 (27.8%) non-obese boys (RR 1.85 95%CI 1.46 to 2.34; P<0.001). The mean durations for achieving testicular volume of ≥4 mL were 21.25 (95%CI 20.75 to 21.74) months in obese boys and 22.26 (95%CI 21.80 to 22.72) months in non-obese boys (P=0.007). The mean durations for achieving Tanner stage P2 were 17.04 (95%CI 16.44 to 17.63) months in obese boys and 20.87 (95%CI 20.05 to 21.68) months in non-obese boys.Conclusion Obesity is associated with earlier onset of sexual maturity in boys.

Reliability of pubertal maturation self-assessment in a school-based survey

2015 ◽  
Vol 28 (3-4) ◽  
Author(s):  
Somchit Jaruratanasirikul ◽  
Piyawut Kreetapirom ◽  
Nattaporn Tassanakijpanich ◽  
Hutcha Sriplung
Keyword(s):  
Line Drawing ◽  
Weighted Kappa ◽  
Pubic Hair ◽  
Kappa Coefficient ◽  
Short Description ◽  
Breast Development ◽  
Self Assessment ◽  
Percent Agreement ◽  
Self Assessments ◽  
Hair Development

AbstractTo assess the reliability of pubertal self-assessment of Thai adolescents.Some 927 girls and 997 boys, aged 8–18 years, from nine schools in Hat-Yai municipality.The adolescents evaluated their pubertal status after being shown a line drawing of the five Tanner stages with a short description. Girls assessed their breast and pubic hair development, and boys assessed their pubic hair development. The pubertal self-assessments were compared to pubertal assessments made by a pediatrician who examined the children after their self-assessment. Kappa coefficient and percent agreement were used for statistical analysis.The percent agreement of breast and pubic hair development between the girl’s self-assessments and the assessments by the pediatrician were 60.8% and 78%, respectively. Kappa coefficient for breast assessment was 0.50 (95% confidence interval, CI 0.47–0.53) and for pubic hair 0.68 (95% CI 0.65–0.72). Nearly 30% of girls aged younger than 10 years overestimated their breast development status while 45% of girls aged over 14 years underestimated their breast development (p<0.001). For boys, the percent agreement of pubic hair development between the adolescents and the pediatrician was 76.4%, with a weighted kappa coefficient of 0.68 (95% CI 0.65–0.72).Pubertal self-assessment using line drawings with a short description can be used as a reliable method to assess pubic hair maturation in boys and girls, but can be used with less reliability to assess the breast maturation in young girls.

Adolescents' Self-Assessment of Sexual Maturation

PEDIATRICS ◽  
1980 ◽  
Vol 66 (6) ◽  
pp. 918-920 ◽  
Author(s):  
Paula M. Duke ◽  
Iris F. Litt ◽  
Ruth T. Gross
Keyword(s):  
Physical Examination ◽  
Developmental Stage ◽  
Sexual Maturation ◽  
Pubertal Development ◽  
Pubic Hair ◽  
Interrater Agreement ◽  
Self Assessment ◽  
Behavioral Measures ◽  
Wide Range ◽  
Physician Rating

The variability in time of onset and progression of puberty warrants the use of stage of sexual maturation rather than chronologic age in assessing biological and behavioral measures during adolescence. The necessity to undress the teenager has seriously curtailed the application of stage of sexual maturation to behavioral and developmental research. This study demonstrates that adolescents can accurately assess their own developmental stage according to Tanner's standard photographs. Self-ratings by 43 females, aged 9 to 17, and 23 males, 11 to 18, were compared to those based on physical examination by one of the investigators. Agreement with the physician rating occurred for breast stage in 37/43, for female pubic hair stage in 40/43, and for male combined pubic hair and genital stage in 21/2 (kappa coefficients: 0.81, 0.91, 0.88). The excellent agreement between physician and adolescent's assessment compared favorably with the interrater agreement of professionals. This study suggests the value of utilizing adolescent self-staging in research. In addition, this exercise provides teenagers with an objective way to understand the wide range of normal pubertal development and to follow their own sexual maturation.

Self-rated Tanner stage and subjective measures of puberty are associated with longitudinal gonadal hormone changes

2019 ◽  
Vol 32 (6) ◽  
pp. 569-576 ◽  
Author(s):  
Ben W.R. Balzer ◽  
Frances L. Garden ◽  
Mazen Amatoury ◽  
Georgina M. Luscombe ◽  
Karen Paxton ◽  
...  
Keyword(s):  
Mass Spectrometry ◽  
Pubertal Development ◽  
Serum Testosterone ◽  
Tanner Stage ◽  
Self Report ◽  
Gonadal Hormone ◽  
Community Based ◽  
Hormone Levels ◽  
Tanner Staging ◽  
Large Community

Abstract Introduction In large community-based studies of puberty, Tanner staging by a clinician is often not possible. We compared self-rated Tanner staging and other subjective ratings of pubertal development with serum hormone levels measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to reassess the utility of self-rated pubertal stage using highly sensitive and specific hormone analysis. Methods Adolescents and their parents enrolled in the Adolescent Rural Cohort study of Hormones and health, Education, environments and Relationships (ARCHER) answered annual survey questions on pubertal development. Annually, adolescents provided blood samples for serum testosterone and estradiol measured by LC-MS/MS. Results Longitudinally, self-rated Tanner stage was positively associated with serum testosterone and estradiol levels in both sexes. Confirmation by adolescent and parent that puberty had commenced was associated with higher gonadal hormone levels in both sexes. Parent and adolescent responses demonstrated ‘fair’ to ‘moderate’ agreement. Conclusions Over a 3-year follow-up, self-rated Tanner staging and simple questions regarding pubertal onset and development are positively associated with adolescent gonadal hormone concentrations in serum measured by mass spectrometry. Thus, self-report of puberty stage still has a role in large community-based studies where physical examination is not feasible.

scholarly journals Precocious Puberty – A Case Report

2016 ◽  
Vol 30 (2) ◽  
pp. 109-112
Author(s):  
Poly Begum ◽  
Dipti Rani Saha ◽  
Md Kamrul Hassan
Keyword(s):  
Precocious Puberty ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Central Precocious Puberty ◽  
Female Child ◽  
Pubic Hair ◽  
Breast Development ◽  
Average Height ◽  
Hypothalamic Pituitary Axis ◽  
Hair Development

The parents of a 04-year-old girl bring her to a Gynaecologist because of breast development, appearance of pubic hair and periodic per vaginal bleeding. Her medical history is unremarkable. The parents are of average height, and the mother reports first menstruating when she was 11 years old. At physical examination, the girl is 100 cm tall , weighs 17 kg, and has a bodymass index of 17. Her pubertal development is classified as Tanner stage 3 breast development and Tanner stage 2 pubic hair development. She was diagnosed as a case of precocious puberity. Appearance of secondary sexual development before the age of 9 in a male child and before the age of 8 in a female child is called precocious puberty. When the cause of precocious puberty is premature activation of the hypothalamic-pituitary axis, it is called central or complete precocious puberty and she was a case of central precocious puberty. After proper consult she was treated by GnRHa suppressor of pituitary till 11 years of age.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(2) : 109-112

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