C10 (Clinical Case) Precocious Puberty in Internationally Adopted Children: A Tale of Two Thelarches

Abstract

Abstract Introduction/Background Internationally adopted (IA) children may commonly experience post-adoption medical issues in the infectious, nutritional, developmental and psychological domains. We present a rare endocrinologic case of 2 biologically unrelated children adopted into the same Canadian family with diagnoses of idiopathic central precocious puberty (CPP), years after adoption. Case Description A 13-month-old female was adopted from Kazakhstan with a past history of prematurity (29 weeks gestational age), grade II intraventricular hemorrhage, query hypoxic ischemic encephalopathy, perinatal CMV infection, and malnourishment. She demonstrated catch-up growth after adoption and was monitored for developmental concerns. She presented at 7 years 9 months with report of thelarche at 6 years 6 months, pubarche at 7 years 6 months and accelerated height velocity. Bone age was advanced by 3 years (+4 SD). By Endocrinology consultation at 8 years 1 month, gonadotropin-releasing hormone (GnRH) stimulation test confirmed CPP. There was no central nervous system (CNS) symptomatology. Leuprolide was initiated to minimize psychosocial impacts of CPP and not necessarily to improve final adult height. Seven years after their first adoption, the family welcomed a female child from Vietnam, aged 2 years 11 months. Medical profile included malnutrition and atopic dermatitis. Thelarche was noted at 5 years 4 months. By Endocrinology consultation at 5 years 5 months, she had isolated breast development with accelerated height velocity. Bone age was advanced by 2.5 years (+3 SD). GnRH stimulation test revealed CPP. Leuprolide was started. MRI brain showed no CNS lesion, which confirmed the diagnosis of idiopathic CPP. Discussion Whereas there is a rare, but documented, increased prevalence of CPP among IA children, etiology is unclear. Theories postulate that it may be related to rapid catch-up growth post-adoption or past exposure to endocrine disruptors. Awareness of this risk may vary. Initial post-adoption consults often focus on other medical and developmental screening. Depending on the age at adoption, counselling about puberty may seem remote. This may impact the timing at which pubertal concerns are identified. As early identification of CPP provides an opportunity to intervene to preserve adult height, as well as minimize psychosocial impact on the child, pubertal surveillance should not be overlooked. Based on caregiver feedback from our cases, we now include counselling on, and examination for, early pubertal changes in our IA clinic visits. Conclusion IA children are at increased risk of central precocious puberty. Paediatric clinicians and caregivers should be aware of this risk to allow for timely identification and treatment of this condition.