Abstract
BackgroundConcerns about psychological distress are often used to justify treatment of girls with precocious puberty, but there is little evidence to support these concerns. The extent to which psychological problems are associated with central precocious puberty (CPP) compared with other forms of early puberty in girls has likewise not been established.MethodsGirls presenting with untreated CPP, premature adrenarche (PA) or early normal puberty (ENP) were recruited from our pediatric endocrine clinic along with their mothers. Child psychological adjustment was assessed by child self-report and parent report. Parent self-reported personality, anxiety, and depression were also assessed. Differences between groups were explored using one-way ANOVA and Dunnett’s T3 test.ResultsSixty-two subjects (aged 7.5 ± 1.4 years, range 4.8-10.5) were enrolled, of whom 19 had CPP, 22 had PA, and 21 had ENP. Girls with ENP were significantly older (8.9 ± .9 years) than girls with CPP (6.9 ± 1.1 years, p < .001) and PA (6.6 ± 1.0 years, p < .001). Girls with PA had significantly higher BMI z-scores (1.7 ± .8) than girls with CPP (1.1 ± .6, p = .01) and ENP (1.2 ± .6, p = .04). More girls with PA and ENP were from racial minorities (47% and 50% respectively) than girls with CPP (32%). No group differences were found for any child measure of psychological adjustment. However, mothers of girls with PA scored significantly higher than mothers of girls with ENP on one measure of depression (p = .04) and stress (p = .01).ConclusionsWhile mothers of girls with PA report increased psychological distress on some measures, no differences in psychological adjustment were found at baseline amongst the girls themselves. Whether these results will change as puberty progresses in the PA and ENP groups or with treatment of CPP is unknown. Long-term prospective studies are needed in order to further investigate psychological correlates of early puberty in girls.
Highlights
Concerns about psychological distress are often used to justify treatment of girls with precocious puberty, but there is little evidence to support these concerns
In this study we examined the extent to which psychological distress is present before treatment in girls with central precocious puberty (CPP) compared to girls with premature adrenarche (PA) and girls with early normal puberty (ENP)
Girls with ENP were significantly older than girls in the other groups (p < .001) and girls with PA had significantly higher BMI z-scores than girls with CPP and ENP (p = .02)
Summary
Concerns about psychological distress are often used to justify treatment of girls with precocious puberty, but there is little evidence to support these concerns. The extent to which psychological problems are associated with central precocious puberty (CPP) compared with other forms of early puberty in girls has likewise not been established. Central precocious puberty (CPP) is due to early activation of the hypothalamic-pituitary-gonadal (HPG) axis prior to the age of 8 in girls or the age of 9 in boys and results in the presence of secondary sexual characteristics and accelerated somatic growth. Medical intervention is warranted in children with CPP to prevent short adult height Another justification for treatment of girls with CPP involves alleviation of psychological distress [6,7]. This concept is primarily extrapolated from studies showing higher rates of problem behaviors and lower academic achievement during adolescence in girls experiencing menarche that is early but still within the normal range. To what extent girls with CPP experience psychological problems and whether treatment alleviates these issues remains unclear
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