Abstract
ObjectiveRecently, we observed some cases of Precocious Puberty (PP) with a partial central activation of hypothalamic-pituitary-gonadal (HPG) axis that tended to normalized in 6–12 months. To evaluate the frequency of this form within the spectrum of forms of PP, we retrospectively assessed the clinical, hormonal and ultrasound characteristics of patients attending to our Center for signs of PP, between 2007 and 2017. To hypothesize some causes of this “pubertal poussée” a questionnaire about environmental data was provided to patients.Methods96 girls were recruited for the study and divided into three Groups. Group 1: 56 subjects with Central PP (CPP) requiring treatment with GnRH analogue; Group 2: 22 subjects with transient activation of pubertal axis, that tended to normalize, “Transient CPP”(T-CPP); Group 3: 18 subjects with Isolated Thelarche (IT).ResultsMean age at diagnosis was 6.8 ± 1.0 years in Group 1, 5.9 ± 1.3 years in Group 2 and 5.6 ± 1.5 years in Group 3. A significant increase of diagnosis of T-CPP was observed over the study period. Significantly higher use of some homeopathic medicines and potential exposure to pesticides was reported in Group 2 vs Group 1.ConclusionsTo our knowledge, we first reported a form defined as T-CPP, characterized by partial activation in the HPG axis normalizing over time. An increased use of homeopathic medicines and exposure to environmental pollutants in these patients was evidenced.
Highlights
Precocious puberty (PP) in girls is defined as the onset of thelarche before 8 years of age [1].The onset of puberty depends on many factors, such as family history, low birth weight, obesity in infancy and early childhood, international adoption, and exposure to endocrine-Within idiopathic forms, Central Precocious Puberty (CPP) does not represent a single entity, but rather a spectrum of forms ranging from Isolated Thelarche (IT) to rapidly progressive CPP [4]
– Group 2: 22 patients with a form of CPP characterized by an intermediate response of LH at the GnRH test, advancement of Bone Age (BA) no more than 1 year compared to Chronological age (CA), longitudinal uterine diameter > 36 mm and/or uterine volume > 3.5 ml
For all patients we retrospectively investigated from medical records: familiar history, socio-economic condition, pregnancy and delivery, age at mother’s menarche, urban or rural residence
Summary
Precocious puberty (PP) in girls is defined as the onset of thelarche before 8 years of age [1].The onset of puberty depends on many factors, such as family history, low birth weight, obesity in infancy and early childhood, international adoption (with a risk of 10–20 times higher), and exposure to endocrine-Within idiopathic forms, Central Precocious Puberty (CPP) does not represent a single entity, but rather a spectrum of forms ranging from Isolated Thelarche (IT) to rapidly progressive CPP [4]. Stanhope et al described for the first time a variant of PP characterized by thelarche and acceleration of growth rate This form was called Thelarche Variant (TV), as it did not develop in CPP and had no response to GnRH analogue [5,6,7]. Among all these forms of non Assirelli et al Italian Journal of Pediatrics (2021) 47:210 progressive or slowly progressive PP, characterized by stabilization or slowly progression of pubertal signs not requiring treatment [8], the degree of activation of Hypothalamic-Pituitary-Gonadal (HPG) axis and his evolutionary trend have never been clarified. In order to evaluate the frequency of this form within the spectrum of forms of PP, we retrospectively assessed the clinical, hormonal and ultrasound characteristics of consecutive patients attending for signs of PP to our Center between 2007 and 2017
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