Abstract
BackgroundDespite the number of reported data concerning idiopathic central precocious puberty (CPP) in girls, major questions remain including its diagnosis, factors, and indications of gonadotropin releasing hormone (GnRH) analog treatment.MethodsA retrospective, single-center study was carried out on 493 girls with CPP.ResultsEleven girls (2.2%) were aged less than 3 years. Breast development was either isolated (Group 0, n = 99), or associated with one sign, pubic hair development, growth rate greater than 2 standard deviation score (SDS) or bone age (BA) >2 years above chronological age, (Group 1, n = 187), two signs (Group 2, n = 142) or three signs (Group 3, n = 65). The interval between onset of puberty and evaluation, body mass index (BMI) SDS, plasma luteinising hormone (LH) concentrations (basal and peak) and LH/ follicle-stimulating hormone (FSH) peak ratio after GnRH test, plasma estradiol and uterus length were significantly greater in Groups 2 and 3 than in Groups 0 and 1 respectively. 211 (42.8%) patients were obese and/or had excessive weight gain during the year before puberty. Obese girls more often had BA advance of >2 years (p = 0.0004) and pubic hair development (p = 0.003) than the others. BMI did not correlate with LH or with LH/FSH peak ratio. Girls with familial history of early puberty (41.4%) had greater frequencies of pubertal LH/FSH peak ratios (p = 0.02) than the others. During the 31 years of the study, there was no increase in the frequency of CPP or variation in its characteristics.ConclusionObesity is associated with a higher BA advance and higher frequency of pubic or axillary hair development but not with LH secretion, suggesting that obesity accelerates adrenarche but not the maturation of the hypothalamic-pituitary-ovarian axis. The LH/FSH peak ratio was more frequently pubertal in girls with a familial history of early puberty, suggesting that this maturation depends on genetic factors.
Highlights
Precocious puberty in girls is defined by the development of sexual characteristics before the age of 8 years [1]
We considered as central precocious puberty (CPP), not premature thelarche (PT), 99 girls for whom at presentation, breast development was clinically isolated but associated with pubertal uterus length, luteinising hormone (LH)/follicle-stimulating hormone (FSH) peak ratio and/or plasma estradiol concentrations or for whom the clinical picture of CPP became complete before 8 years of age
The LH/FSH peak ratio and the plasma estradiol concentrations were prepubertal in 5 of these girls, but pubertal development progressed before 8 years in all, leading to treatment with gonadotropin releasing hormone (GnRH) analogs in all but case 5
Summary
Precocious puberty in girls is defined by the development of sexual characteristics before the age of 8 years [1]. It may correspond to premature thelarche (PT), which is defined by non-pathological isolated early breast development, generally during the first two years of life, but progression from PT to CPP occurs in 13% of cases [2,3]. This finding led to the hypothesis that PT and CPP may represent different positions along a continuum of hypothalamic gonadotropin releasing hormone (GnRH) neuron activation [4]. Despite the number of reported data concerning idiopathic central precocious puberty (CPP) in girls, major questions remain including its diagnosis, factors, and indications of gonadotropin releasing hormone (GnRH) analog treatment
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