Can Body Mass Index Affect Height Growth at Menarche among Girls Receiving Treatment for Early Puberty? A Retrospective Study in Korean Girls

Gonadotropin-releasing hormone agonist (GnRHa) therapy is used to control puberty progression and it preserves height potential in patients with idiopathic central precocious puberty (ICPP). This study evaluated the correlation between weight and height gain at menarche following GnRHa treatment among girls with ICPP and relatively central early puberty (EP). We investigated height/weight trends and changes in height from diagnosis to menarche in girls with ICPP and EP treated with GnRHa. The mean difference in height (Δheight) from treatment cessation to menarche was 9.79 ± 3.53 cm. Girls were divided into girls with Δheight ≥ 9.79 cm (Group 1) and girls with Δheight < 9.79 cm (Group 2). Although near adult height was significantly higher in Group 1, the mean body mass index (BMI) and weight were significantly lower at diagnosis, treatment discontinuation, and menarche. The BMI and weight at the three time points were negatively correlated with height. Girls with higher BMI at all three time points had slower growth rates during the study period. Considering that BMI and body weight were closely related to Δheight, proper management of BMI and body weight of girls receiving early puberty treatment might contribute to growth during and after GnRHa treatment.

Psychometric Challenges in the Measurement of Constructs Underlying Criminal Responsibility in Children and Young Adults: A Cross-Sectional Study

At present, many countries have lowered the minimum age of criminal responsibility to deal with the trend of juvenile crime. In practical terms, whether countries advocate for lowering the age of criminal responsibility along with early puberty, or regulating the minimum age of juvenile criminal responsibility through their policies, their deep-rooted hypothesis is that age is tied to adolescents’ psychological growth, and, with the rise in age, the capacity for dialectical thinking, self-control, and empathy gradually improves. With this study, we aimed to test whether this hypothesis is valid. The participants were 3,208 students from junior high school, senior high school, and freshman in the S province of the People’s Republic of China (PRC). We subjected the gathered materials to independent-samples t-tests, one-way analysis of variance (ANOVA), linear regression analysis, and Bonferroni post hoc test. The influence of the age variable upon dialectical thinking, self-control, and empathy was significant (p = 0.002, p = 0.000, p = 0.072), but only empathy was positively correlated with age variable (B = 0.032); dialectical thinking ability (B = −0.057), and self-control ability (B = −0.212) were negatively correlated with the age variable. Bonferroni post hoc test confirmed these findings. Therefore, we concluded the following: (1) Juvenile criminal responsibility, based on the capacity for dialectical thinking, self-control, and empathy, is not positively correlated with age. (2) Age is not the only basis on which to judge a juvenile’s criminal responsibility. (3) More research that directly links age differences in brain structure and function to age differences in legally relevant capacities and capabilities(e.g., dialectical thinking, self-control, and empathy) is needed. (4) Political countries should appropriately raise the minimum age of criminal responsibility and adopt the doli incapax principle in the judicial process.

Precocious Puberty: Causes, Consequences, Daily Environmental Factors, and the need for Community/Societal Support

Precocious puberty, otherwise described as a group of medical conditions that cause early puberty onset, such as a pre-adolescent boy presenting with adult pattern of penile and testicular enlargement or a pre-adolescent girl presenting with mature breast development and onset of menses. Although the sexual and physical characteristics for this condition are well-described in medical literature, the causes are very rarely known. Nevertheless, it has substantial impacts on children’s lives. This is a review on sexual development, premature sexual development, the social complications children suffer from due to early onset puberty, and the associations with daily environmental exposures as possible influences for developing precocious puberty.

Sedentary lifestyle and precocious puberty in girls during COVID-19 pandemic: an Italian experience

Objective: This retrospective study aimed to evaluate children observed for suspected precocious puberty in 5 Italian centers of Pediatric Endocrinology during the first wave of COVID-19 pandemic (March- September 2020), compared to subjects observed in the same period of the previous year. Design: The study population (490 children) was divided according to year of observation and final diagnosis: transient thelarche (TT), non-progressive precocious puberty (NPP), central precocious puberty (CPP), or early puberty (EP). Results: Between March and September 2020, 338 subjects were referred for suspected precocious puberty, compared to 152 subjects in the same period of 2019 (+222%). The increase was observed in girls (328 subjects in 2020 versus 140 in 2019, p<0.05), especially during the second half of the period considered (92 girls from March to May versus 236 girls from June to September); while no difference was observed in boys (10 subjects in 2020 versus 12 in 2019). The percentage of girls with confirmed CPP was higher in 2020, compared to 2019 (135/328 girls [41%] versus 37/140 [26%], p<0.01). Anthropometric and hormonal parameters in 2019 and 2020 CPP girls were not different; 2020 CPP girls showed a more prolonged use of electronic devices and a more sedentary lifestyle both before and during the pandemic, compared to the rest of the 2020 population. Conclusions: The present findings corroborate the recently reported association between the complex lifestyle changes related to the lockdown and a higher incidence of central precocious puberty in Italian girls.

High prevalence of early endocrine disorders after childhood brain tumors in a large cohort

Objective To describe the endocrine follow-up of patients with primary brain tumors. Methods non interventional observational study, data collection from medical records of 221 patients followed at a Pediatric Endocrinology Department. Results 48.9% were female, median age at diagnosis: 6.7 years (range: 0-15.9), median follow-up: 6.7 years (0.3-26.6). Main tumor types: medulloblastoma (37.6%), craniopharyngioma (29.0%) and glioma (20.4%). According to anatomical location, 48% were suprasellar (SS) and 52% non-suprasellar (NSS). GH deficiency (GHD) prevalence was similar in both groups (SS: 83.0%, NSS: 76.5%, p=0.338), appearing in median 1.8 years (-0.8 to 12.4) after diagnosis; post-radiotherapy GHD appeared in median 1.6 years after radiotherapy (0.2 to 10.7). Hypothyroidism was more prevalent in SS (76.4%), than NSS (33.9%), p&lt;0.001, as well as ACTH deficiency (SS: 69.8%, NSS: 6.1%, p&lt;0.001). Early puberty was similar in SS (16%) and NSS (12.2%). Hypogonatropic hypogonadism was predominant in SS (63.1%) vs NSS (1.3%), p&lt;0.001, and post-chemotherapy gonadal toxicity in NSS (29.6%) vs SS (2.8%), p&lt;0.001. Adult height was lower for NSS compared to target height (-1.0 SD, p&lt;0.0001) and to SS patients (p&lt;0.0001). Thyroid nodules were found in 13/45 patients (28.8%), including 4 cancers (4.8-11.5 years after radiotherapy). Last follow-up visit BMI was higher in both groups (p=0.0001), obesity incidence was higher for SS (46.2%) than NSS (17.4%). Conclusions We found a high incidence of early onset endocrine disorders. An endocrine consultation and nutritional evaluation should be mandatory for all patients with a brain tumor, especially when the tumor is suprasellar or after hypothalamus/pituitary irradiation.

The Value of Urinary Gonadotropins in the Diagnosis of Central Precocious Puberty: A Meta-Analysis

Review question / Objective: Precocious puberty is defined as the onset of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys. It can be differentiated into central precocious puberty (CPP) and peripheral precocious puberty, and it is more common in girls than in boys. CPP may result in a decreased final adult height, an early age at menarche, and psychological and health problems in adulthood. Gonadotropin-releasing hormone (GnRH) GnRH stimulation test has been indispensable in the diagnosis of CPP. GnRH stimulation test is not only invasive, time-consuming and expensive, but also sometimes difficult to have patients cooperate. Nocturnal urinary LH and FSH can represent gonadotropin excretion in children with normal and early puberty. And urinary sample collection and evaluation are more convenient, more acceptable, cheaper, and noninvasive. This meta-analysis aims to assess the value of first-voided urinary luteinizing hormone (LH) and the ratio of urinary luteinizing hormone and follicle-stimulating hormone (FSH) in the diagnosis of female CPP and to compare the accuracy between urinary gonadotropins and serum GnRH-stimulated gonadotropins.

The Role of Pediatric Nutrition as a Modifiable Risk Factor for Precocious Puberty

Puberty is a critical phase of growth and development characterized by a complex process regulated by the neuroendocrine system. Precocious puberty (PP) is defined as the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal. The timing of puberty has important public health, clinical, and social implications. In fact, it is crucial in psychological and physical development and can impact future health. Nutritional status is considered as one of the most important factors modulating pubertal development. This narrative review presents an overview on the role of nutritional factors as determinants of the timing of sexual maturation, focusing on early-life and childhood nutrition. As reported, breast milk seems to have an important protective role against early puberty onset, mainly due to its positive influence on infant growth rate and childhood overweight prevention. The energy imbalance, macro/micronutrient food content, and dietary patterns may modulate the premature activation of the hypothalamic–pituitary–gonadal axis, inducing precocious activation of puberty. An increase in knowledge on the mechanism whereby nutrients may influence puberty will be useful in providing adequate nutritional recommendations to prevent PP and related complications.

Use of growth hormone in region 19p13.3 microduplication syndrome in girl with central early puberty: a clinical case report

Chromosomal mutations involving 19p13.3 have been described as pathogenic. clinical and phenotypic features can include, in most cases, psychomotor development delay, microcephaly, typical facial appearance, hand and foot anomalies, umbilical hernia, hypotonia, and low percentage of lean mass. The main types of mutation found on this chromosome are deletion or duplication. Short stature is often the cause of medical demand and the use of exogenous GH for patients with this syndrome is not beneficial. This article reports the case of a 5-year-old girl who sought medical help due to short stature and was diagnosed with this syndrome. Furthermore, this case study may contribute to the dissemination in the medical community about the association of this genetic mutation with the child's clinical condition, warning about this syndrome, and the possibility of the occurrence of early puberty. This study was analyzed and approved by the Research Ethics Committee (CEP) according to a substantiated opinion number 4.765.113.