GROWTH DISTURBANCES AND VALUES FOR HORMONE EXCRETION IN VARIOUS FORMS OF PRECOCIOUS SEXUAL DEVELOPMENT

PEDIATRICS ◽  
1961 ◽  
Vol 28 (2) ◽  
pp. 258-275
Author(s):  
Pierre Ferrier ◽  
Thomas H. Shepard ◽  
Elizabeth Knapp Smith
Keyword(s):  
Precocious Puberty ◽  
Sexual Development ◽  
Laboratory Finding ◽  
Vaginal Smear ◽  
Bone Maturation ◽  
Premature Thelarche ◽  
Sexual Precocity ◽  
Premature Adrenarche ◽  
Primordial Dwarfism ◽  
Hormone Excretion

Forty-two children with precocious sexual development have been classified according to: a) constitutional sexual precocity, b) premature adrenarche, and c) premature thelarche. Constitutional sexual precocity and premature adrenarche are associated with excessive growth, advance in bone maturation, and elevation of the urinary 17-ketosteroids. In contrast, in premature thelarche growth, bone maturation and 17-ketosteroids were normal. The presence of estrogenization of the vaginal smear was the most helpful laboratory finding in differentiating constitutional sexual precocity from the other two conditions. The presence of detectable urinary gonadotropins in precocious puberty is of limited help. Two patients with primordial dwarfism and associated precocious puberty are reported. The occurrence of constitutional precocious puberty in a brother and a sister is described. This is apparently the first reported instance in which familial precocious puberty occurs in either sex.

scholarly journals Precocious puberty in girls: a clinical case of idiopathic central precocious puberty

2021 ◽  
Vol 12 (1) ◽  
pp. 71-77
Author(s):  
Olga V. Lagno ◽  
Maria E. Turkunova ◽  
Elena B. Bashnina
Keyword(s):  
Precocious Puberty ◽  
Sexual Development ◽  
Clinical Case ◽  
Central Precocious Puberty ◽  
Gonadotropin Releasing Hormone ◽  
Bone Maturation ◽  
Important Place ◽  
Releasing Hormone ◽  
Pediatric Endocrinologist ◽  
Diagnostic Difficulties

Central precocious puberty occupies an important place in the practice of a pediatric endocrinologist. If the patient reveals signs of premature sexual development, the diagnostic search is aimed at eliminating the tumor origin of both false (peripheral) and gonadotropin-dependent, or central, precocious puberty, as well as gonadotropin-independent forms of premature sexual development. Oncological alertness is important in the work of not only a pediatric endocrinologist, but also a pediatrician. In the treatment of all non-tumor forms of central precocious puberty, drugs of the group of analogues of gonadotropin-releasing hormone are used, which allows to stop the progression of sexual development, reduce the rate of bone maturation and, thereby, increase the final growth of the child. The most common idiopathic variant of central precocious puberty. The article presents a clinical case of observing a patient with an idiopathic variant of central premature sexual development during therapy with a drug from the group of analogues of gonadotropin releasing hormone of prolonged action. The classical course of the idiopathic variant of central precocious puberty with typical diagnostic difficulties in the onset of the disease, good compensation against the background of therapy with a drug from the group of agonists of gonadotropin-releasing hormone and normal puberty 612 months after cancellation of the therapy is demonstrated. The latter is explained by the proven reversibility of the effects of this group of drugs. The description of this clinical case, in the authors opinion, should be of interest to doctors at the local pediatricians and pediatricians working in the medical care departments for children in educational institutions.

scholarly journals Aetiology of Percociuos Puberty in Patients Presenting to A Tertiary Care Hospital

2018 ◽  
Vol 41 (3) ◽  
pp. 143-146
Author(s):  
Tasnima Ahmed ◽  
Fauzia Mohsin ◽  
Nasreen Islam ◽  
Juben Nahar ◽  
Shahida Akhter ◽  
...  
Keyword(s):  
Precocious Puberty ◽  
Adrenal Adenoma ◽  
Tertiary Care ◽  
Central Precocious Puberty ◽  
Hypothalamic Hamartoma ◽  
Care Hospital ◽  
Laboratory Findings ◽  
Cross Sectional ◽  
Premature Thelarche ◽  
Premature Adrenarche

Background: Precocious puberty is a common paediatric endocrine disorder seen in clinical practice. This study was carried out to find out the aetiology of precocious puberty in children presenting in a tertiary care hospital.Methodology: This cross sectional study was done at paediatric endocrine outpatient department at BIRDEM General Hospital from July 2005 to June 2015. The clinical data as well as laboratory findings were collected from consecutive patients who presented for evaluation of precocious puberty.Result: Seventy one patients presented with precocious puberty during this study period. There was female preponderance (71.8%). The mean age at presentation of girls and boys were 4.8±2.1 years and 6.63±1.4 years respectively. Among the 51 girls who presented with precocious puberty 22(43.1%) had central precocious puberty (CPP), 5(9.8%) had peripheral precocious puberty (PPP) and 24(47%) had incomplete precocious puberty (IPP). Among the 22 girls with CPP 19(86.3%) were idiopathic & 3(13.6%) girls were hypothyroid. Among the 5 girls with PPP, 3(60%) had congenital adrenal hyperplasia (CAH) & 2(40%) had adrenal adenoma. In case of incomplete precious puberty among 24 girls, 20 (83.3%) had premature thelarche, 1(4.1%) had premature menarche & 3 (12.5%) had premature adrenarche. In 20 boys with precocious puberty, 7(35%) had CPP. Among them 3(42.8%) boys had hypothalamic hamartoma, 1(14.2%) boy had craniopharyngioma and other 3(42.8%) boys had idiopathic CPP. PPP was present in 11(55%) boys. Among them 8(72.7%) patient had CAH, 2(18.1%) had adrenal adenoma and 1(9.0%) had hepatoblastoma. Premature adrenarche was present in 2(10%) boys.Conclusions: Precocious puberty was more commonly found among girls as compared to boys. Central precocious puberty was more common among girls and majority were idiopathic. Among boy precocious pseudopuberty was more common and CAH was the commonest cause. Majority of boy with central precocious puberty had organic brain lesion.Bangladesh J Child Health 2017; VOL 41 (3) :143-146

scholarly journals Organochloride Pesticides in Macedonian Girls With Premature Sexual Development

2007 ◽  
Vol 10 (1) ◽  
pp. 43-48
Author(s):  
M Krstevska-Konstantinova ◽  
M Kocova ◽  
C Charlier ◽  
J Bourguignon
Keyword(s):  
Precocious Puberty ◽  
Sexual Development ◽  
Positive Association ◽  
Serum Levels ◽  
Mean Value ◽  
Control Group ◽  
Early Puberty ◽  
Premature Thelarche ◽  
Negative Results ◽  
Organochloride Pesticides

Organochloride Pesticides in Macedonian Girls With Premature Sexual DevelopmentPremature sexual development (PSD) in girls describes the appearance of secondary sexual signs before the age of 8 years. Early puberty is diagnosed if pubertal signs appear between the age of 8 and 9 years. We found a positive association between the levels of organochloride pesticides (p,p'-DDE) in precocious puberty in girls adopted from developing countries and significantly higher levels than in native Belgian girls with the same condition.We have compared the serum levels of eight p,p'- DDE in 56 Macedonian girls with PSD and a control group of 24 normal, age-matched girls, using a gas chromatographic analyzer coupled to a tandem mass spectrometer detector. Of the 56 girls with PSD, 42 had premature thelarche, five had early puberty, and nine had precocious puberty of idiopathic (n = 8) or organic (n = 1) origin. We found traces of p,p'- DDE in nine girls (16%) and negative results in 41 (73%), while the remaining six (10%) had a mean level of 1.17 ± 0.7 μg/L. In the control group, traces were found in one girl (4%) and negative results in 18 (75%), while the remaining five (20%) had a mean level of 1.18 ± 0.6 μg/L. We found elevated levels of lindane in the girls with PSD (mean value 1.2 ± 0.8) and significantly higher levels in the control group (1.4 ± 0.8) (p <0.05). We concluded that Macedonian girls with PSD do not have higher levels of p,p'-DDE in their serum than the normal controls. However, the elevated levels of lindane in this population should be further investigated.

ETIOLOGIC INTERRELATIONSHIP IN DOWN'S SYNDROME, HYPOTHYROIDISM, AND PRECOCIOUS SEXUAL DEVELOPMENT

PEDIATRICS ◽  
1967 ◽  
Vol 40 (4) ◽  
pp. 590-595
Author(s):  
H. F. Pabst ◽  
S. Pueschel ◽  
D. A. Hillman
Keyword(s):  
Precocious Puberty ◽  
Sexual Development ◽  
Thyroid Autoimmunity ◽  
Down's Syndrome ◽  
Animal Experiments ◽  
Down’S Syndrome ◽  
Pertinent Literature ◽  
Sexual Precocity ◽  
Tsh Stimulation

This report describes results of endocrine and immunological investigations performed on an 8-year-old, hypothyroid, mongoloid girl with precocious puberty. Based on these studies, animal experiments, and a review of the pertinent literature, it is suggested that the observed hypothyroidism and Down's syndrome may both be related to thyroid autoimmunity, and the sexual precocity may be due to the response of the ovary to excessive TSH stimulation.

Effect of MPA on Male Precocious Puberty

PEDIATRICS ◽  
1974 ◽  
Vol 54 (3) ◽  
pp. 381-382
Author(s):  
James N. Powell ◽  
Edgar J. Schoen
Keyword(s):  
Adverse Effects ◽  
Precocious Puberty ◽  
Medroxyprogesterone Acetate ◽  
Sexual Development ◽  
Spontaneous Remission ◽  
Adrenocortical Function ◽  
Testicular Function ◽  
Bone Maturation ◽  
Uncommon Disease

Medroxyprogesterone acetate (MPA) has been used by some in the hope of averting dwarfism in male idiopathic isosexual precocious puberty (MIIPP). MPA is known to suppress sexual development; whether it slows bone maturation is unproved. Its use is controversial.1-5 One cannot determine what height the patient with this uncommon disease might have reached without treatment; spontaneous remission occasionally occurs in MIIPP; reported adverse effects of MPA therapy include suppression of adrenocortical function, and disordered testicular function and histology,2-4,6,7 which some have feared would be permanent.

The pattern of gonadotropin and estradiol secretion in exaggerated thelarche

1993 ◽  
Vol 128 (4) ◽  
pp. 345-350 ◽  
Author(s):  
Luigi R Garibaldi ◽  
Thomas Aceto ◽  
Colleen Weber
Keyword(s):  
Precocious Puberty ◽  
Central Precocious Puberty ◽  
Bone Age ◽  
Premature Thelarche ◽  
Premature Adrenarche ◽  
Estradiol Secretion ◽  
Secretory Potential ◽  
Estrogen Effects ◽  
Estrogen Effect ◽  
Similar Peak

Purpose: To assess the dynamics of the pituitary-ovarian axis in exaggerated thelarche, defined as premature thelarche associated with signs of systemic estrogen effects (advanced bone age and/or growth acceleration) without progression to complete puberty. Subjects and methods: Seven girls (age <2.5 years) with exaggerated thelarche, 6 girls with inactive pituitary-ovarian axis (premature adrenarche) and 21 girls with activated axis (central precocious puberty) had serum FSH, LH and E2 measured serially before and 1 to 24 h after gonadotropin-releasing hormone agonist (GnRHa) administration (leuprolide, 20 μg/kg sc), used as a test of combined pituitary-ovarian stimulation. Results: Although girls in the exaggerated thelarche and adrenarche group had similar [mean (SEM)] baseline FSH [3.2 (0.9) vs 1.4 (0.3) IU/I], LH [0.36(0.1) vs 0.27 (0.02) IU/I] and E2 [20 (1.2) vs 21 (2) pmol/l] concentrations, and similar peak post-GnRHa LH concentrations [5.5 (1.1) vs 2.4 (0.5) IU/I], girls with exaggerated thelarche achieved higher peak FSH [41(9) vs 14 (3) IU/I, p< 0.01] and E2 [243 (40) vs 37 (6) pmol/l, p<0.001] concentrations after GnRHa. In comparison to patients with exaggerated thelarche, girls with precocious puberty had higher (p<0.01-0.001) baseline LH [3.6 (0.8) IU/I], baseline E2 [69 (11) pmol/l], GnRHa-stimulated peak LH [68 (1 7) IU/I] and peak E2 [648 (58) pmol/l] concentrations, but similar FSH parameters. Conclusions: Girls with exaggerated thelarche exhibit substantial E2 secretory potential that can be demonstrated by GnRHa stimulation, is predominantly FSH-driven, and probably accounts for the manifestations of estrogen effect seen in these girls.

Assessment of gonadotropin concentrations stimulated by gonadotropin-releasing hormone analog by electrochemiluminescence (ECLIA) in girls with precocious puberty and premature thelarche

2021 ◽  
Author(s):  
Kamila Botelho Fernandes de Souza ◽  
Melyna Shayanne Pessôa Veiga ◽  
Gabriela Ráina Ferreira Martins ◽  
Adriana Paula da Silva ◽  
Lívia Grimaldi Abud Fujita ◽  
...  
Keyword(s):  
Precocious Puberty ◽  
Central Precocious Puberty ◽  
Bone Age ◽  
Gonadotropin Releasing Hormone ◽  
Assay Method ◽  
Premature Thelarche ◽  
Releasing Hormone ◽  
Cutoff Values ◽  
Hormone Analog ◽  
Hormone Analogs

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 the 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). 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.

scholarly journals Update on the etiology, diagnosis and therapeutic management of sexual precocity

2008 ◽  
Vol 52 (1) ◽  
pp. 18-31 ◽  
Author(s):  
Vinicius Nahime Brito ◽  
Ana Claudia Latronico ◽  
Ivo J. P. Arnhold ◽  
Berenice Bilharinho Mendonça
Keyword(s):  
Precocious Puberty ◽  
Sex Steroids ◽  
Therapeutic Option ◽  
Receptor Gene ◽  
Pubertal Development ◽  
Protein A ◽  
Activating Mutations ◽  
Sexual Precocity ◽  
Gonadotropic Axis ◽  
Hormonal Evaluation

Precocious puberty is defined as the development of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys. Gonadotropin-dependent precocious puberty (GDPP) results from the premature activation of the hypothalamic-pituitary-gonadal axis and mimics the physiological pubertal development, although at an inadequate chronological age. Hormonal evaluation, mainly through basal and GnRH-stimulated LH levels shows activation of the gonadotropic axis. Gonadotropin-independent precocious puberty (GIPP) is the result of the secretion of sex steroids, independently from the activation of the gonadotropic axis. Several genetic causes, including constitutive activating mutations in the human LH-receptor gene and activating mutations in the Gs protein a-subunit gene are described as the etiology of testotoxicosis and McCune-Albright syndrome, respectively. The differential diagnosis between GDPP and GIPP has direct implications on the therapeutic option. Long-acting gonadotropin-releasing hormone (GnRH) analogs are the treatment of choice in GDPP. The treatment monitoring is carried out by clinical examination, hormonal evaluation measurements and image studies. For treatment of GIPP, drugs that act by blocking the action of sex steroids on their specific receptors (cyproterone, tamoxifen) or through their synthesis (ketoconazole, medroxyprogesterone, aromatase inhibitors) are used. In addition, variants of the normal pubertal development include isolated forms of precocious thelarche, precocious pubarche and precocious menarche. Here, we provide an update on the etiology, diagnosis and management of sexual precocity.

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