scholarly journals Variantes normales del desarrollo puberal y pubertad precoz: Análisis de dos casos clínicos

2016 ◽  
Vol 3 (1) ◽  
pp. 77
Author(s):  
Lucía Rivero ◽  
Carlos Zunino ◽  
María Noel Cuadro ◽  
Gustavo Giachetto
Keyword(s):  
Growth Rate ◽  
Precocious Puberty ◽  
Normal Growth ◽  
Bone Age ◽  
Pubic Hair ◽  
Breast Size ◽  
Secondary Sexual Characteristics ◽  
Sexual Characteristics ◽  
Cranial Mri

Introduction: Precocious puberty is defined as the appearance of secondary sexual characteristics before the age of 8 in girls and 9 in boys. Objective: Emphasize the Pediatrician´s role in the diagnosis, treatment and follow-up of patients with precocious puberty. Description: Case 1: Girl, 4 years and 11 months old. Thin and scarce pubic hair since 6 months of age. No hypertrophy of the clitoris or breast. Overweight. Normal growth rate and neurodevelopment. Examination: scarce curly pubic hair, non-estrogenic mucosa. Increase in breast size. Breast ultrasound shows lipomatosis. Bone age: 5 years. Case 2: Girl, 6 years and 11 months old. Painful bilateral and symmetric breast growth, no galactorrhea.  Oppressive, moderate and non-progressive headache. No intracranial hypertension. Pubarche, no menarche. Adequate neurodevelopment. Obese. Growth rate above the 90 percentile. Tanner III. Non-estrogenic genital mucosa. Bone age: 13 years. Gynecological ultrasound shows prepubertal uterus. Normal FSH, LH, estradiol, prolactin, TSH, T4 and cranial MRI. Treatment is initiated with leuprolide acetate. Discussion The appearance of thelarche, pubarche or menarche in patients with normal bone age, as in Case 1, constitutes an ordinary variation of puberty. However, as shown in Case 2, the presence of multiple sexual characteristics and advanced bone age must be considered as precocious puberty indicators. Pediatricians have an important role in the diagnosis and treatment of precocious puberty, as well as in the patient´s follow-up. Both anamnesis and physical examination are key to guide the diagnosis.

REPLACEMENT ORAL ETHINYLOESTRADIOL THERAPY FOR GONADAL DYSGENESIS: GROWTH AND ADRENAL ANDROGEN STUDIES

1979 ◽  
Vol 91 (3) ◽  
pp. 519-528 ◽  
Author(s):  
Anne W. Lucky ◽  
Samuel P. Marynick ◽  
Robert W. Rebar ◽  
Gordon B. Cutler ◽  
Michael Glen ◽  
...  
Keyword(s):  
Gonadal Dysgenesis ◽  
Bone Age ◽  
Pubic Hair ◽  
Height Velocity ◽  
First Year ◽  
Adrenal Androgen ◽  
Secondary Sexual Characteristics ◽  
Sexual Characteristics ◽  
Second Year ◽  
Pre Treatment

ABSTRACT We have studied growth and adrenal dehydroepiandrosterone (DHA) responses to iv synthetic adrenocorticotrophic hormone (ACTH, Cortrosyn) in 6 girls with gonadal dysgenesis before and during treatment with lowdose ethinyloestradiol (EOe2). In all patients there was a statisfactory induction of secondary sexual characteristics including increase in breasts and pubic hair and onset of withdrawal bleeding within 6 months of therapy. Height velocity increased from 2.8 ± 0.9 cm/year pre-treatment to 5.3 ± 1.5 cm/year (P < 0.02) in the first year. There was deceleration to 1.9 ± 1.1 cm/year in the second year. There was no disproportionate advancement in bone age and thus, presumably, no loss of ultimate height. We could demonstrate no change in basal or ACTH-stimulated levels of DHA, a specific adrenal androgen, to account for the increased pubic hair and growth in these patients.

scholarly journals Central Precocious Puberty in Boys and Girls: Similarities and Differences

Sexes ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 119-131
Author(s):  
Cristina Mucaria ◽  
Nina Tyutyusheva ◽  
Giampiero I. Baroncelli ◽  
Diego Peroni ◽  
Silvano Bertelloni
Keyword(s):  
Precocious Puberty ◽  
Central Precocious Puberty ◽  
Bone Age ◽  
Gnrh Analog ◽  
Secondary Sexual Characteristics ◽  
Sexual Characteristics ◽  
The Central Nervous System

Central precocious puberty (CPP) is due to the premature activation of the hypothalamic–pituitary–gonadal axis, which is responsible for the appearance of secondary sexual characteristics. It occurs before the age of 8 and 9 in girls and boys, respectively. CPP shows higher incidence in females than in males. Causes of CPP are similar in both sexes, but the idiopathic form is more frequent in girls, while organic forms are more frequent in males. Recent studies demonstrated a role of some genetic variants in the pathogenesis of CPP. The diagnostic evaluation based on accurate physical examination, assessment of the pituitary–gonadal axis, pelvic sonography in girls, and determination of bone age. Magnetic resonance of the central nervous system should be done in all boys and selected girls. Since the 1980s, pharmacologic treatment involves the use of gonadotropin-releasing hormone (GnRH) analogs. These drugs are characterized by few side effects and long-term safety. Many data are available on the outcome of GnRH analog treated female patients, while poor data are reported in boys. Adult height is improved in both sexes.

scholarly journals Central Precocious Puberty in a Three-Year-Old Girl

2021 ◽  
Vol 27 (3) ◽  
pp. 341
Author(s):  
Suryani Jamal ◽  
Liong Boy Kurniawan ◽  
Suci Aprianti ◽  
Ratna Dewi Artati ◽  
Ruland DN Pakasi ◽  
...  
Keyword(s):  
Physical Examination ◽  
Precocious Puberty ◽  
Tanner Stage ◽  
Central Precocious Puberty ◽  
Bone Age ◽  
Breast Development ◽  
Hypothalamic Hamartoma ◽  
Secondary Sexual Characteristics ◽  
Pelvic Ultrasonography ◽  
Sexual Characteristics

Precocious puberty is defined as the onset of secondary sexual characteristics before 8 years of age in girls and 9 years in boys. Central Precocious Puberty (CPP) is caused by early activation of the hypothalamic-pituitary-gonadal axis. Laboratory test of LH, FSH, and Estradiol is recommended for monitoring suppressive effects from GnRHa therapy in the early three months and every six months. This study aimed to report a case of CPP in a 3-year and 3-month-old girl. A 3-year and 3-month-old girl went to the hospital with vaginal bleeding (menstruation), breast development, and pubic and axilla hair for 7-month-old. Physical examination found moderately ill with obesity, body weight 20 kg, height 98 cm. Tanner stage was A2M3P2, café au lait was found in the left forehead with size 7x3.5 cm. In March 2015 before GnRHa therapy, LH, FSH and Estradiol level increased with levels of 4.32 mlU/mL, 6.01 mlU/mL, and 67 pg/mL, and after 3 months of the treatment was 0.87 mlU/mL, 2.51 mlU/mL and <20 pg/mL. Pelvic ultrasonography showed suggestive precocious puberty, bone age 5-year and 9-month (Greulich and Pyle), CT-Scan of the brain showed hypothalamic tumor suspected hypothalamic hamartoma. This patient was treated with a GnRHa injection every 4 weeks. Leuprorelin is a synthetic non-peptide analogue of natural GnRH. The diagnosis was based on medical history, physical examination, laboratory, and radiological findings. The prognosis of the patient was good.

Constitutional Delay of Growth: Expected versus Final Adult Height

PEDIATRICS ◽  
1991 ◽  
Vol 87 (1) ◽  
pp. 82-87 ◽  
Author(s):  
Stephen LaFranchi ◽  
Cheryl E. Hanna ◽  
Scott H. Mandel
Keyword(s):  
Adult Height ◽  
Hormone Secretion ◽  
Growth Hormone Secretion ◽  
Human Growth ◽  
Normal Growth ◽  
Bone Age ◽  
Final Adult Height ◽  
Constitutional Delay ◽  
Height Predictions

Constitutional delay of growth and puberty is believed to represent a variation of normal growth, and it is expected that children with this condition will grow for a longer duration than average and reach a height that is normal for their genetic potential. The records of children with constitutional delay of growth and puberty who were initially seen in the Pediatric Endocrine Clinic at the Oregon Health Sciences University between 1975 and 1983 were retrospectively reviewed. Criteria for study included a height more than 2 SD below the mean, a significantly delayed bone age, and a normal growth velocity on follow-up. Forty-two subjects were located and final adult height measurements were obtained. At contact, the 29 male subjects (mean age = 23.9 years) were 169.5 ± 4.5 cm tall (mean ± SD), and the 13 female subjects (mean age = 20.5 years) were 156 ± 3.8 cm tall. Adult height predictions during follow-up, using either the Bayley-Pinneau or Roche-Wainer-Thissen method, were close to final adult heights. The males were 1.2 SD and the females 1.3 SD below the 50th percentile as adults. This finding was not fully explained by genetic short stature; the males fell 5.1 cm and the females 5.3 cm below target heights based on midparental heights. It is concluded that this discrepancy is most likely explained by a selection bias of the shortest children referred to and observed in a subspecialty clinic, although a defect in human growth hormone secretion or function in children at the far end of the spectrum of constitutional delay of growth and puberty cannot be excluded.

Anthropometric, metabolic, and reproductive outcomes of patients with central precocious puberty treated with leuprorelin acetate 3-month depot (11.25 mg)

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Carolina O. Ramos ◽  
Ana P M Canton ◽  
Carlos Eduardo Seraphim ◽  
Aline Guimarães Faria ◽  
Flavia Rezende Tinano ◽  
...  
Keyword(s):  
Precocious Puberty ◽  
Adult Height ◽  
Central Precocious Puberty ◽  
Bone Age ◽  
Overweight And Obesity ◽  
Leuprorelin Acetate ◽  
The Mean ◽  
Hormone Analogs

Abstract Objectives Longer-acting gonadotropin-releasing hormone analogs (GnRHa) have been widely used for central precocious puberty (CPP) treatment. However, the follow-up of patients after this treatment are still scarce. Our aim was to describe anthropometric, metabolic, and reproductive follow-up of CPP patients after treatment with leuprorelin acetate 3-month depot (11.25 mg). Methods Twenty-two female patients with idiopathic CPP were treated with leuprorelin acetate 3-month depot (11.25 mg). Their medical records were retrospectively evaluated regarding clinical, hormonal, and imaging aspects before, during, and after GnRHa treatment until adult height (AH). Results At the diagnosis of CPP, the mean chronological age (CA) was 8.2 ± 1.13 year, and mean bone age (BA) was 10.4 ± 1.4 year. Mean height SDS at the start and the end of GnRHa treatment was 1.6 ± 0.8 and 1.3 ± 0.9, respectively. The mean duration of GnRHa treatment was 2.8 ± 0.8 year. Mean predicted adult heights (PAH) at the start and the end of GnRH treatment was 153.2 ± 8.6 and 164.4 ± 7.3 cm, respectively (p<0.05). The mean AH was 163.2 ± 6.2 cm (mean SDS: 0.1 ± 1). All patients were within their target height (TH) range. There was a decrease in the percentage of overweight and obesity from the diagnosis until AH (39–19% p>0.05). At the AH, the insulin resistance and high LDL levels were identified in 3/17 patients (17.6%) and 2/21 patients (9.5%), respectively. The mean CA of menarche was 12.2 ± 0.5 years. At the AH, PCOS was diagnosed in one patient (4.8%). Conclusions Long-term anthropometric, metabolic, and reproductive follow-up of patients with CPP treated with longer-acting GnRHa revealed effectivity, safety, and favorable outcomes.

scholarly journals Congenital Hypothyroidism with Precocious Puberty-A Case Report

2011 ◽  
Vol 24 (1) ◽  
pp. 48-50
Author(s):  
M Sanaul Haque ◽  
SN Hasnain ◽  
MI Haque ◽  
MA Hossain ◽  
MI Bari
Keyword(s):  
Case Report ◽  
Congenital Hypothyroidism ◽  
Precocious Puberty ◽  
Vaginal Bleeding ◽  
Rare Case ◽  
Rare Condition ◽  
Bone Age ◽  
Pubic Hair ◽  
Breast Development

Congenital hypothyroidism with precocious puberty is a rare condition. In this report a rare case of congenital hypothyroidism with precocious puberty is described. A 10 years old girl presented with feature of hypothyroidism together with breast development, vaginal bleeding, lack of pubic hair and delayed bone age. She also had multicystic ovaries. She was treated with L-thyroxine and improved TAJ 2011; 24(1): 48-50

Low-Dose Testosterone Effect on Somatic Growth

PEDIATRICS ◽  
1986 ◽  
Vol 77 (6) ◽  
pp. 593-857
Author(s):  
Robert L. Rosenfield
Keyword(s):  
Growth Rate ◽  
Turner Syndrome ◽  
Low Dose ◽  
Anabolic Steroids ◽  
Somatic Growth ◽  
Tanner Stage ◽  
Bone Age ◽  
Pubic Hair ◽  
Growth Potential ◽  
Average Dose

Low-dose testosterone has been found to preserve the growth potential of hypogonadal children requiring anabolic or androgenic therapy. Five girls with Turner syndrome were treated when their chronologic ages were 13 to 14 years and their bone ages were 10.6 to 12.75 years; six hypogonadal boys were treated when their chronologic ages were 11 to 15 years and their bone ages were 10.9 to 14.2 years. Depot testosterone was given as an anabolic agent in an average dose of 28 mg/m2/mo for 6 months to the patients with Turner syndrome and was given to initiate puberty in an average dose of 44 mg/m2/mo for 6 months to the hypogonadal boys. Growth rate doubled on these doses of testosterone, and bone age did not advance disproportionately. Consequently, height potential was preserved. Pubic hair advanced one Tanner stage during the 6-month treatment. Clitoral hypertrophy was observed in only one of the five girls with Turner syndrome and regressed when testosterone therapy was discontinued. Four hypogonadal boys were continued on low-dose testosterone until their bone ages passed 14 years of age and their growth rate waned. Then, the testosterone dosage was increased in increments to 100 to 200 mg/m2/mo. This group reached a height of 100.3 ± 0.8% of the height initially predicted. In addition, all attained an adult height at least 15 percentiles greater than that before therapy. These studies indicate that testosterone in very low doses resembles "anabolic steroids" in that growth is stimulated without an inordinate androgenic effect. Furthermore, these studies show that institution of low-dose therapy in the early teenage years stimulates pubertal growth normally without loss of height potential.

Letters to the Editor

PEDIATRICS ◽  
1973 ◽  
Vol 52 (1) ◽  
pp. 150-150
Author(s):  
Gertrude Costin ◽  
Maurice D. Kogut
Keyword(s):  
Thyroid Hormone ◽  
Clinical Data ◽  
Pubic Hair ◽  
Breast Development ◽  
Letters To The Editor ◽  
Female Patients ◽  
Secondary Sexual Characteristics ◽  
Adequate Therapy ◽  
Sexual Characteristics ◽  
Axillary Hair

Drs. Costin and Kogut comment as follows: We were pleased to read Dr. Comas' letter in which he describes a 12-4/12-year-old girl whose clinical data suggest that she may be an example of the syndrome that we reported. The evidence for this was the occurrence of menstruation, pubic hair, and breast development when the patient was hypothyroid and disappearance of menstruation following treatment with thyroid hormone. It is not clear why Dr. Comas' patient had an increase in pubic hair and appearance of axillary hair following treatment at a time when her menstrual periods ceased; in all the reported female patients regression of the secondary sexual characteristics was noted following adequate therapy.

Testosterone Therapy for Pubertal delay

1992 ◽  
Vol 13 (1) ◽  
pp. 5-39
Keyword(s):  
Anabolic Steroids ◽  
Pubic Hair ◽  
Height Velocity ◽  
Delayed Puberty ◽  
Secondary Sexual Characteristics ◽  
Self Image ◽  
Pubertal Delay ◽  
Constitutional Delay ◽  
Sexual Characteristics ◽  
Age Appropriate

Despite considerable variation in the age at which puberty normally begins, a male adolescent who has demonstrated neither testicular nor pubic hair growth by 14 years of age is considered to have delayed puberty. Although such delay may indicate hypopituitarism or isolated gonadotropin deficiency, most commonly it represents a normal variation, termed "constitutional delay in growth and maturation." Such patients eventually will enter puberty and achieve normal sexual maturation and adult height. However, during adolescence, such delays may be accompanied by impaired self-image and social isolation. Under these conditions, many pediatric endocrinologists advocate short-term use of anabolic steroids. Such therapy is aimed at accelerating height velocity during the ensuing year, accompanied by the development of age-appropriate secondary sexual characteristics.

THE TREATMENT OF PRECOCIOUS PUBERTY WITH CYPROTERONE ACETATE

1973 ◽  
Vol 74 (2) ◽  
pp. 399-408 ◽  
Author(s):  
K. Rager ◽  
R. Huenges ◽  
D. Gupta ◽  
J. R. Bierich
Keyword(s):  
Urinary Excretion ◽  
Precocious Puberty ◽  
Cyproterone Acetate ◽  
Vaginal Bleeding ◽  
Pubic Hair ◽  
Breast Size ◽  
Height Increment ◽  
Bone Maturation ◽  
Growth Prognosis ◽  
Axillary Hair

ABSTRACT Nine patients (8 girls and 1 boy) suffering from precocious puberty received daily 100 mg/m2 cyproterone acetate orally. This treatment inhibited the vaginal bleeding; breast-size and the axillary hair and pubic hair did not further increase. The height increment per year and the bone maturation slowed down. The urinary excretion of androgens was temporarily diminished. It is probable that the growth prognosis could be improved by the administration of cyproterone acetate.

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