scholarly journals Precocious puberty: diagnosis and management

2021 ◽  
Vol 12 (1) ◽  
pp. 62-69
Author(s):  
Nusrat Sultana ◽  
Faria Afsana ◽  
Nazma Akhtar ◽  
Yasmin Aktar ◽  
Mohammad Feroz Amin ◽  
...  
Keyword(s):  
Precocious Puberty ◽  
Normal Development ◽  
Central Precocious Puberty ◽  
Gnrh Analogues ◽  
Premature Thelarche ◽  
Psychosocial Wellbeing ◽  
Epiphyseal Fusion ◽  
Final Stature ◽  
Biochemical Testing ◽  
Peripheral Precocious Puberty

Precocious puberty is commonly defined as puberty that starts before age 8 years in girls and 9 years in boys. The causes of it may range from a variant of normal development to various pathologic conditions. The etiology of precocious puberty is classified by the underlying pathogenesis into gonadotropin dependent central precocious puberty and peripheral precocious puberty which is independent of gonadotropin but due to different other causes. Variants of precocious puberty include premature thelarche, premature puberche and isolated premature menarche which imply onset of isolated changes without any other signs of sexual development. Precocious puberty might have an impact on final stature owing to premature epiphyseal fusion and also it has got influence on psychosocial wellbeing. Evaluation includes a detailed history, physical examination, biochemical testing and imaging directed towards suspected etiology. Gonadotropin releasing hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the specific cause. Pubertal variants are usually non-progressive and need no treatment but should be monitored carefully. BIRDEM Med J 2022; 12(1): 62-69

scholarly journals Precocious puberty: a clinical review

2018 ◽  
Vol 7 (3) ◽  
pp. 771
Author(s):  
Pallavee P. ◽  
Rupal Samal
Keyword(s):  
Precocious Puberty ◽  
Pubertal Development ◽  
Psychosocial Problems ◽  
Central Precocious Puberty ◽  
Biochemical Tests ◽  
Gnrh Analogues ◽  
Premature Thelarche ◽  
Epiphyseal Fusion ◽  
Peripheral Precocious Puberty

Precocious puberty is defined as pubertal development occurring more than 2.5 standard deviations earlier than the average age. It may comprise of central or gonadotropin-dependent precocious puberty and peripheral or gonadotropin-independent precocious puberty. Variants of precocious puberty include premature thelarche, premature pubarche and isolated premature menarche which principally implies onset of menstruation without any other signs of sexual development. Precocious puberty may have long-term consequences including short stature later on in adulthood owing to premature epiphyseal fusion as also psychosocial problems. Evaluation includes a detailed history, physical examination, biochemical tests and imaging directed towards detecting the cause. Gonadotropin Releasing Hormone (GnRH) analogues are effective for treatment of central precocious puberty. Treatment of peripheral precocious puberty should be based on the cause. Isolated variants are usually normal but should be closely monitored. Multi-speciality consultation with involvement of pediatricians and enocrinologists may improve treatment outcomes in these children, who otherwise pose significant challenges to the gynaecologist.

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.

AMH levels at central precocious puberty and premature thelarche: is it a parameter?

2015 ◽  
Vol 28 (11-12) ◽  
Author(s):  
Nursel Muratoglu Sahin ◽  
Sibel Tulgar Kinik ◽  
Mustafa Agah Tekindal ◽  
Nilufer Bayraktar
Keyword(s):  
Precocious Puberty ◽  
Central Precocious Puberty ◽  
Breast Development ◽  
Premature Thelarche ◽  
Pubertal Onset ◽  
Antimullerian Hormone ◽  
The Mean ◽  
Antimüllerian Hormone

AbstractThe possible difference of antimüllerian hormone (AMH) levels at central precocious puberty (CPP) and premature thelarche (PT) has not been properly evaluated.By evaluating AMH levels in girls with diagnosed CPP and PT, we aim to show the change of AMH levels at the pubertal onset.Sixty-five girls who have breast development before the age of 8 years and 25 healthy girls were enrolled in the study.The subjects were divided into two groups as CPP and PT, according to results of GnRH test. AMH levels were determined in the two groups.The mean AMH levels of the CPP group were significantly lower than those in the PT group (13.57±9.85 pmol/L and 58.42±12.78 pmol/L, respectively, p=0.022).These results suggest that the AMH levels decrease in the duration of the hypothalamus-pituitary-ovarian axis activation. We thought that AMH might/may be a marker for distinguishing between CPP and PT.

Progression of premature thelarche to central precocious puberty

1995 ◽  
Vol 126 (1) ◽  
pp. 11-14 ◽  
Author(s):  
Anna Maria Pasquino ◽  
Ida Pucarelli ◽  
Franca Passeri ◽  
Maria Segni ◽  
Maria Antonietta Mancini ◽  
...  
Keyword(s):  
Precocious Puberty ◽  
Central Precocious Puberty ◽  
Premature Thelarche

scholarly journals Adult Height in Girls with Central Precocious Puberty Treated with Gonadotropin-Releasing Hormone Analogues and Growth Hormone

1999 ◽  
Vol 84 (2) ◽  
pp. 449-452 ◽  
Author(s):  
Anna Maria Pasquino ◽  
Ida Pucarelli ◽  
Maria Segni ◽  
Marco Matrunola ◽  
Fabio Cerrone
Keyword(s):  
Precocious Puberty ◽  
Adult Height ◽  
Final Height ◽  
Pubertal Development ◽  
Central Precocious Puberty ◽  
Chronological Age ◽  
Control Group ◽  
Bone Maturation ◽  
Gnrh Analogues ◽  
Age Progression

GnRH analogues (GnRHa) represent the treatment of choice in central precocious puberty (CPP), because arresting pubertal development and reducing either growth velocity (GV) or bone maturation (BA) should improve adult height. However, in some patients, GV decrease is so remarkable that it impairs predicted adult height (PAH); and therefore, the addition of GH is suggested. Out of twenty subjects with idiopathic CPP (treated with GnRHa depot-triptorelin, at a dose of 100 μg/kg im every 21 days, for at least 2–3 yr), whose GV fall below the 25th percentile for chronological age, 10 received, in addition to GnRHa, GH at a dose of 0.3 mg/kg·week sc, 6 days weekly, for 2–4 yr; and 10 matched for BA, chronological age, and duration of GnRHa treatment, who showed the same growth pattern but refused GH treatment, served to evaluate the efficacy of GH addition. No patient showed classical GH deficiency. Both groups discontinued treatment at a comparable BA (mean ± sem): 13.2 ± 0.2 in GnRHa plus GH vs. 13.0 ± 0.1 yr in the control group. At the conclusion of the study, all the patients had achieved adult height. Adult height was considered to be attained when the growth during the preceding year was less than 1 cm, with a BA of over 15 yr. Patients of the group treated with GH plus GnRHa showed an adult height significantly higher (P &lt; 0.001) than pretreatment PAH (160.6 ± 1.3 vs. 152.7 ± 1.7 cm). Target height (TH) was significantly exceeded. The group treated with GnRH alone reached an adult height not significantly higher than pretreatment PAH (157.1 ± 2.5 vs. 155.5 ± 1.9 cm). TH was just reached but not significantly exceeded. The gain in centimeters obtained, calculated between pretreatment PAH and final height, was 7.9 ± 1.1 cm in patients treated with GH combined with GnRHa; whereas in patients treated with GnRHa alone, the gain was just 1.6 ± 1.2 cm (P = 0.001). Furthermore, no side effects have been observed either on bone age progression or ovarian cyst appearance and the gynecological follow-up in the GH-treated patients (in comparison with those treated with GnRHa alone). In conclusion, a gain of 7.9 cm in adult height represents a significant improvement, which justifies the addition of GH for 2–3 yr during the conventional treatment with GnRHa, especially in patients with CPP, and a decrease in GV so marked as to impair PAH, not allowing it to reach even the third centile.

scholarly journals SUN-097 Gonadotropins Levels Measurement in First Morning Voided Urine as a Diagnostic Tool for Central Precocious Puberty

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Wasawee Sakdinun ◽  
Oranut Komkhum ◽  
Voraluck Phatarakijnirund ◽  
Phairuch Chaiyakul ◽  
Nawaporn Numbenjapon
Keyword(s):  
Precocious Puberty ◽  
Gnrh Agonist ◽  
Central Precocious Puberty ◽  
Height Velocity ◽  
Close Monitoring ◽  
Operating Characteristics ◽  
Premature Thelarche ◽  
Cutoff Value ◽  
Basal Serum ◽  
Serum Lh

Abstract Background: GnRH stimulation test is the gold standard for the diagnosis of central precocious puberty (CPP). However, it is invasive and costly. Previous studies showed that increased urinary gonadotropins (Gn) level in first morning voided (FMV) urine reflected the integration of elevated nocturnal Gn secretions. Therefore, it could be used to diagnose CPP. Nevertheless, its cutoff value for diagnosis of CPP is limited. Objective: To determine the association of Gn levels in FMV urine and serum during pubertal development and establish cutoff value of FMV urinary Gn as an alternative noninvasive method for diagnosis of CPP in girls. Methods: Sixty-one girls who had breast development before 8 years of age with sign of rapid pubertal progression (advanced bone age and/or increased height velocity) underwent subcutaneous GnRH agonist test. FMV urinary Gn were also collected on the same day. Both serum and urinary Gn levels were measured using electrochemiluminescence immunoassay (ECLIA) technique. The definite diagnosis of CPP is based on stimulated serum LH &gt; 5 IU/L. FMV urinary Gn were compared between CPP and premature thelarche (PT) groups. The correlation between serum and urinary Gn were assessed and the cutoff value of urinary Gn to diagnose CPP was established. FMV urinary Gn of 480 Thai school girls (control) were also collected to determine the reference values according to their breast Tanner (BT) stages. Results: FMV ULH level in girls with CPP was significantly higher than that of PT (2.46 VS 0.8 IU/L; median, P &lt;0.001). However, the level of ULH in PT group was not different from control group with BT1. FMV ULH and ULH: UFSH were well correlated with basal serum LH (r=0.63 and 0.73, respectively, Ps&lt;0.001) and peak serum LH (r=0.44 and 0.54, respectively, Ps&lt;0.001). Base on receiver operating characteristics analysis, basal serum LH was the best parameter to differentiate CPP from PT (area under the curve 0.797–0.926). ULH levels at ≥ 1.13 IU/L and ≥ 1.52 provide optimal sensitivity (72.3 and 68.1 %, respectively) and specificity (85.7 and 100 %, respectively). Combined ULH level ≥ 1.13 IU/L with ULH: UFSH ≥ 0.17 increased specificity from 85.7 to 92.9 % for predicting a positive GnRH agonist test. (peak LH ≥ 5 IU/L) Conclusions: First morning voided urinary Gn levels measurement is a highly potential method for the diagnosis of CPP in girls due to its good correlation with GnRH agonist test. Further study in a larger number of patients with close monitoring of clinical outcome is required before recommending as a standard investigation in CPP.

The relation of urinary bisphenol A with kisspeptin in girls diagnosed with central precocious puberty and premature thelarche

2016 ◽  
Vol 29 (3) ◽  
Author(s):  
İlker Tolga Özgen ◽  
Emel Torun ◽  
Bilge Bayraktar-Tanyeri ◽  
Erdem Durmaz ◽  
Elif Kılıç ◽  
...  
Keyword(s):  
Bisphenol A ◽  
Precocious Puberty ◽  
Endocrine Disruptor ◽  
Statistical Difference ◽  
Daily Life ◽  
Central Precocious Puberty ◽  
Gonadotropin Releasing Hormone ◽  
Control Group ◽  
Premature Thelarche ◽  
Prepubertal Girls

AbstractBisphenol A (BPA) is known as an endocrine disruptor and it is supposed to have a role on the development of central precocious puberty (CPP). Kisspeptin, a hypothalamic peptide, is a neuromodulator of gonadotropin releasing hormone and it has an important role on regulation of the onset of puberty. The BPA levels in girls with CPP and premature thelarche (PT) and its relation with kisspeptin levels were investigated.Twenty-eight girls with CPP, 28 girls with PT and 22 prepubertal girls as a control group were enrolled to the study. Urinary BPA and serum kisspeptin levels were compared in the groups. Bivariate correlations were performed to evaluate the relations of BPA with kisspeptin and estradiol.There was no statistical difference between groups regarding BPA levels. Serum kisspeptin levels were higher in CPP group than controls [306.56 (interquartile range (IQR), 175.63–504.66) vs. 157.62 (IQR, 55.61–285.00) p: 0.008]. There were no correlations between BPA and kisspeptin levels (r: 0.088, p: 0.391) and between BPA and estradiol (r: –0.171, p: 0.144).The BPA levels did not differentiate between groups and it seems that the exposed amount of BPA in daily life did not affect kisspeptin levels in girls with CPP and PT.

scholarly journals Central Precocious Puberty as a Complication of Therapy with Adrenocorticotropin (ACTH) and an Aromatase Inhibitor for Refractory Nephrotic Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Sungeeta Agrawal ◽  
Robert Gensure ◽  
Lawrence Milner ◽  
Julie Nicoletta ◽  
Abdollah Sadeghi-Nejad
Keyword(s):  
Nephrotic Syndrome ◽  
Renal Transplant ◽  
Aromatase Inhibitor ◽  
Precocious Puberty ◽  
Idiopathic Nephrotic Syndrome ◽  
Central Precocious Puberty ◽  
Adrenal Androgens ◽  
Refractory Nephrotic Syndrome ◽  
Peripheral Precocious Puberty

Glucocorticoids are typically prescribed for the treatment of idiopathic nephrotic syndrome of childhood. In selected patients with refractory focal segmental glomuerulosclerosis (FSGS), adrenocorticotropin (ACTH) can be used to induce remission and decrease the progression of the disease. We report a 6 8/12-year-old girl with recurrent proteinuria, resistant to standard immunotherapy. She underwent related renal transplant but again developed proteinuria and was started on ACTH. She subsequently developed peripheral precocious puberty (PPP), presumably from peripheral aromatization of adrenal androgens. She was started on an aromatase inhibitor, and her ACTH dose was slowly decreased. She then developed central precocious puberty (CPP). We hypothesize that treatment of her peripheral precocious puberty with an aromatase inhibitor may have triggered central precocious puberty.

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

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