Diagnosis Of Precocious Puberty Research Articles

Artificial intelligence in paediatric endocrinology: conflict or cooperation.

Artificial intelligence (AI) in medicine is transforming healthcare by automating system tasks, assisting in diagnostics, predicting patient outcomes and personalising patient care, founded on the ability to analyse vast datasets. In paediatric endocrinology, AI has been developed for diabetes, for insulin dose adjustment, detection of hypoglycaemia and retinopathy screening; bone age assessment and thyroid nodule screening; the identification of growth disorders; the diagnosis of precocious puberty; and the use of facial recognition algorithms in conditions such as Cushing syndrome, acromegaly, congenital adrenal hyperplasia and Turner syndrome. AI can also predict those most at risk from childhood obesity by stratifying future interventions to modify lifestyle. AI will facilitate personalised healthcare by integrating data from 'omics' analysis, lifestyle tracking, medical history, laboratory and imaging, therapy response and treatment adherence from multiple sources. As data acquisition and processing becomes fundamental, data privacy and protecting children's health data is crucial. Minimising algorithmic bias generated by AI analysis for rare conditions seen in paediatric endocrinology is an important determinant of AI validity in clinical practice. AI cannot create the patient-doctor relationship or assess the wider holistic determinants of care. Children have individual needs and vulnerabilities and are considered in the context of family relationships and dynamics. Importantly, whilst AI provides value through augmenting efficiency and accuracy, it must not be used to replace clinical skills.

Precocious puberty in relation to the COVID-19 pandemic. A survey among Argentine pediatric endocrinologists

Introduction. Puberty is manifested initially by the onset of secondary sexual characteristics as a result of hormonal changes that progressively lead to complete sexual maturity. In Argentina and worldwide, the lockdown resulting from the SARS-CoV-2 pandemic may have interfered in the onset and timing of pubertal development. Objective. To describe the perception of pediatric endocrinologists in Argentina regarding consultations for suspected precocious and/or rapidly progressive puberty during the pandemic. Materials and methods. Descriptive, observational, cross-sectional study. Anonymous survey among pediatric endocrinologists members of the Sociedad Argentina de Pediatría and/or the Asociación de Endocrinología Pediátrica Argentina administered in December 2021. Results. Out of 144 pediatric endocrinologists, 83 completed the survey (rate of response: 58%). All of them considered that consultation for precocious or early puberty increased, either in terms of early thelarche (84%), early pubarche (26%), and/or precocious puberty (95%). Ninety-nine percent agreed that this has occurred to a greater extent in girls. All survey respondents also consider that the diagnosis of central precocious puberty has increased. In total, 96.4% of respondents consider that the number of patients treated with GnRH analogs has increased. Conclusion. Our results about the perception of pediatric endocrinologists are consistent with data published in other regions on the increase in the diagnosis of precocious puberty during the COVID-19 pandemic. We underscore the need to develop national registries of central precocious puberty, and to disseminate the evidence for a timely detection and management.

An overview of deep learning applications in precocious puberty and thyroid dysfunction.

In the last decade, deep learning methods have garnered a great deal of attention in endocrinology research. In this article, we provide a summary of current deep learning applications in endocrine disorders caused by either precocious onset of adult hormone or abnormal amount of hormone production. To give access to the broader audience, we start with a gentle introduction to deep learning and its most commonly used architectures, and then we focus on the research trends of deep learning applications in thyroid dysfunction classification and precocious puberty diagnosis. We highlight the strengths and weaknesses of various approaches and discuss potential solutions to different challenges. We also go through the practical considerations useful for choosing (and building) the deep learning model, as well as for understanding the thought process behind different decisions made by these models. Finally, we give concluding remarks and future directions.

047 Multifactorial obesity: The influence of obesity on pubertal development and the HPG axis

Around 370 million children worldwide are overweight or obese [DiCesare], which poses a serious threat to global health perspective. Obesity is a disease, which means that once obese, the biological systems change to a different setpoint which makes losing weight with lifestyle intervention only very difficult. We know that nutritional status is an important regulator of growth and puberty. This presentation will focus on the impact of obesity in children on growth and puberty. BMI gain as well as obesity are related to an increased height gain during childhood and taller stature. However, not at birth or at 18 years. One of the explanations is that obese children stop growing earlier because they have an advanced bone age. Several hormones are suggested as possible mediators for this effect on growth and bone age: insulin, leptin or sex steroids like androgens or estrogens. No definite candidate has been identified yet, but both leptin and estrogen are important hormones in activating the hypothalamic-pituitary-gonadal axis. Leptin is a hormone produced by fat tissue. It informs the brain on the body’s energy storage. When there is too little, the body will not enter puberty, which costs a lot of energy. Estrogen is produces by gonads, but also by adipose tissue by aromatization of androgens into estrogens. Adrenal androgen levels are increased in children with obesity. Data from large cohort studies show that BMI and obesity are associated with early start of puberty, early pubarche and younger age of menarche. Physicians treating children and adolescents need to bear in mind that childhood obesity is associated with alterations in growth and pubertal development [ 1 Di Cesare M. Sorić M. Bovet P. Miranda J.J. Bhutta Z. Stevens G.A. Laxmaiah A. et al. The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med. 2019; 17: 212 Crossref PubMed Scopus (269) Google Scholar , 2 de Groot C.J. van den Berg A. Ballieux B. Kroon H.M. Rings E.H.H.M. Wit J.M. et al. Determinants of advanced bone age in childhood obesity. Horm Res Paediatr. 2017; 87: 254-263 Crossref PubMed Scopus (21) Google Scholar , 3 He Q. Karlberg J. Bmi in childhood and its association with height gain, timing of puberty, and final height. Pediatr Res. 2001; 49 Crossref PubMed Scopus (319) Google Scholar , 4 Sørensen K. Mouritsen A. Aksglaede L. Hagen C.P. Mogensen S.S. Juul A. Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty. Horm Res Paediatr. 2012; 77: 137-145 Crossref PubMed Scopus (215) Google Scholar , 5 Eckert-Lind C. Busch A.S. Petersen J.H. Biro F.M. Butler G. Bräuner E.V. Juul A. Worldwide secular trends in age at pubertal onset assessed by breast development among girls: A systematic review and meta-analysis. JAMA Pediatr. 2020; 174: e195881 Crossref PubMed Scopus (84) Google Scholar ].

Reduction in pediatric growth hormone deficiency and increase in central precocious puberty diagnoses during COVID 19 pandemics

BackgroundWhile several studies have been published so far on the effect of COVID-19 pandemic on health care for non-COVID-19 diseases, to date no study evaluated the impact of the COVID-19 pandemic on the entire field of pediatric endocrinology. This study aimed to evaluate differences in pediatric endocrine stimulation tests after the advent of COVID-19 pandemics.MethodsRetrospective study with data collection for pediatric endocrine stimulation tests performed in 2019 and 2020 in a tertiary center.ResultsOverall, 251 tests were performed on 190 patients in 2020, compared to 278 tests on 206 patients in 2019 (− 10% tests; − 8% children evaluated). A significant reduction was found in tests to diagnose growth hormone deficiency (GHD) (− 35%), while LHRH tests increased (+ 22%). A reduction of 30% in GHD diagnosis was observed. Central precocious puberty (CPP) diagnosis increased by 38% compared to 2019, mainly in females.ConclusionThis study found a significant reduction of tests investigating GHD during COVID-19 pandemics. It also showed a clinically meaningful increase in cases of CPP in girls. These results suggest the need for families and pediatricians to monitor children’s growth during isolation and enlighten new perspectives towards conditions associated with lockdown restrictions as increased screen time, social isolation, and children’s anxiety as possible triggers of CPP.

Evaluation of etiological, laboratory, and anthropometric characteristics of patients treated with the diagnosis of precocious puberty

Evaluation of etiological, laboratory, and anthropometric characteristics of patients treated with the diagnosis of precocious puberty

Gonadotropin-releasing hormone stimulation test and diagnostic cutoff in precocious puberty: a mini review.

The gonadotropin-releasing hormone (GnRH) stimulation test is a valuable tool in diagnosing and differentiating causes of early pubertal occurrences. Utility of the test can be limited in some instances, however, including the early phases of pubertal hypothalamic-pituitary-gonadal axis activation, in girls showing commonly overlapping pictures, and in obese children due to excess circulating estrogen that suppresses luteinizing hormone (LH). A lack of consistent baseline and stimulated gonadotropin cutoffs observed in different studies also contributes to limitations in testing. Nevertheless, early detection of true pathological causes for pubertal disorders is needed to allow prompt treatment and better prognosis. While basal LH can be beneficial as a good screening tool for detecting pubertal disorder, it does not preclude the need for GnRH testing. The aim of this review was to highlight the role of GnRH stimulation tests and varying testing cutoffs in diagnosis of precocious puberty and its classification.

Diagnosis of Precocious Puberty in Girls

Puberty is one of the most astonishing periods of human life, when significant physical alterations occur along with psychosocial maturation. Precocious Puberty (PP) is defined as the appearance and progressive development of secondary sexual characteristics at a younger age than the general population, i.e. for Caucasian girls before 8 years of age. Untreated precocious puberty usually leads to short stature and can also cause significant emotional and behavioral issues. In recent years, an increased incidence of PP has been found in many countries although several studies now suggest that this trend has slowed down over the last decade in most industrialized countries, while persisting in other countries. Some girls with idiopathic precocious puberty may also have slowly progressive pubertal development without deterioration of their predicted height over a 2-year follow-up period. It is important to determine which girls to treat and the role of the clinician remains crucial. The clinician also needs to be familiar with the terminology of pubertal progression. The aim of this review was to examine the diagnosis of central precocious puberty (CPP) taking in account clinical practice and international literature.

SUN-063 Usefulness of a LHRH Test with Low Dose of Triptorelin Pamoate in the Diagnosis of Precocious Puberty in Girls

Objective: to determine diagnosis value of a new LHRH test for diagnosis or precocious puberty (PP) correlated with clinical and paraclinical pubertal changes. Methods:79 girls under age 10 years old were referred to our laboratory with diagnosis of precocious puberty went thought a physical exam and bone age /pelvic US review to classify them clinically in probably PP or unlikely PP. A LHRH test was performed with measurement of at least 3 times including baseline measurement of gonadotrophins (LH / FSH) and estradiol 0-24 hours after a dose of 100 mcg/m2 (max 100 mcg) of Triptorelin Pamoate. The results for LH greater than 8 uUI / L and estradiol of 80 pg / ml were considered positive - Results: From 79 girls, mean age 8,02 years old (+/- 2,2) 41 were classified as likely PP (group 1) and 38 unikely PP (group 2) On group 1, 39 patients (95,1 %) had results of LH above 8 uUI/L. In this group, 5 patients (12.1%) had estradiol results below 80 pg / ml. Of the positive test, 3 patients (7,6%) %) had LH peak time 60 min, 4 patients (10,2%) had LH peak time 90 min, 31 (79,4%) had LH peak at time 180 minutes. In group 2, 3 patients (7,89 %) had values of estradiol above 80 pg/ml and 1 patient had values above 8 uUI/ml. Sensitivity was 95,1% specificity 97,4%, predicted positive value 97,5% and negative predicted value 95%. Conclusion: Low dose LHRH test for precocious puberty with 100 mcg/m2 of Pamoate Triptorelin is a useful tool in the diagnosis of precocious puberty in girls, with high sensitivity and specificity and with lower cost than other diagnostic tools.

Analysis of the cut point of peak level of luteinizing hormone in gonadotropin-releasing hormone agonist test in obese girls with precocious puberty

Objective To explore the significance of the cut point of peak level of luteinizing hormone(LH) in gonadotropin-releasing hormone (GnRH) agonist test in the diagnosis of precocious puberty in obese girls. Methods According to the diagnostic criteria of children′s central precocious puberty diagnosis consensus (2015), 796 cases of precocious puberty (peak level of LH ≥3.3 IU/L) in Children′s Hospital of Zhejiang University School of Medicine from January 2014 to December 2015 were divided into normal weight group (573 cases), overweight group (170 cases) and obesity group (53 cases). The 3 groups were compared in terms of basic level of LH, basic level of follicle stimulating hormone (FSH), peak level of LH and FSH, ratio of LH(peak)/FSH(peak), sex hormone binding protein (SHBG), and children with 3.3 IU/L ≤peak level of LH <5.0 IU/L were followed up.The accuracy of the diagnosis of central precocious puberty using peak level of LH was analyzed by using receiver operating characteristic (ROC) curve. Results The median of LH (peak) in the obese group was 6.92 IU/L, the median of SHBG was 46.52 nmol/L, the median of LH (peak) in normal weight group was 8.92 IU/L, and the median of SHBG was 87.28 nmol/L.There were significant differences between the 2 groups (P<0.05, 0.001). A total of 89 cases in normal weight group and 65 cases of obesity/overweight group (3.3 IU/L ≤peak level of LH <5.0 IU/L) were followed up for 1 year, and 18 cases in normal weight group and 33 cases in obesity/overweight group developed to central precocious puberty, while the number of cases in the 2 groups was significantly different (P<0.001). The ROC curve analysis showed that the cut point of peak level of LH was 4.16 IU/L, the sensitivity was 0.606, the specificity was 0.656, and the Jordan index was the largest (0.344). Conclusions The peak level of LH in GnRH agonist test is important for the diagnosis of central precocious puberty in girls, but the effect of body mass index on its cut point needs to be considered. Key words: Body mass index; Precocious puberty; Gonadotropin-releasing hormone agonist test; Receiver operating characteristic curve

Value of color Doppler ultrasonography in the diagnosis of precocious puberty in girls

Objective To assess the role of pelvic ultrasound examination in discriminating between normal girls,isolated premature thelarche/pubarche /menarche and central precocious puberty (CPP).Methods Eighty-four isolated premature thelarche/pubarche /menarche cases,47 CPP cases,and 177 normal girls aged 0-10 years were recruited.All diagnoses were confirmed by the gonadotropin-releasing hormone-stimulation test.All subjects underwent pelvic ultrasound examination for the measurement of length,width,thickness,and volume of the uterine body,uterine cervix,and ovary,and the number of follicles with diameter≥ 4 mm.The groups were subdivided by age intervals when the difference in ultrasound measurements between CPP,isolated premature thelarche/pubarche/menarche,and normal girls were analyzed.Results 1) Differentiation between CPP and normal girls:for the 6-8 years,there were 11 variables elevated in CPP as compared to the normal girls.Uterine cervix thickness was the most efficient parameter as judged by the largest value of area under the ROC curve (0.958).The best cut-off,sensitivity,and specificity was 0.73 cm,93.30％,and 85.70％ respectively;for the 8-10 years,uterine body volume was the best parameter among the 10 elevated variables as judged by the largest area under the ROC curve (0.869),3.23 cm3 was the best cut-off limit with a sensitivity of 84.21％ and a specificity of 52.11％.2) Differentiation between isolated premature thelarche/pubarche/menarche and normal girls:for the 0-6 years,ovary thickness was the best variable as judged by the largest area under the ROC curve (0.806),0.98cm was the best cut-off limit with a sensitivity of 76.46％ and a specificity of 84.85 ％ ;for the 6-8 years,ovary width was the best variable among the 8 valuable variables for its largest area under the ROC curve (0.843),1.39 cm was the best cut-off limit with a sensitivity of 85.71％ and a specificity of 73.81％ respectively;for the 8-10 years,uterine cervix thickness was the best variable among the 5 valuable variables for its largest area under ROC curve (0.841),0.75 cm was the best cut-off limit with a sensitivity of 90.48％ and a specificity of 64.21％.3) Differentiation between CPP and isolated premature thelarche/ pubarche/menarche cases:for the 6-8 years,uterine cervix length and width were potential parameters.Uterine cervix length was the best variable for its largest area under the ROC curve(0.764),and 1.49 cm was the best cut-off limit,the corresponding sensitivity and specificity was 93.33％ and 55.17％ respectively;for the 8-10 years,3 variables could be used,among which uterine cervix length was the best variable for its largest area under the ROC curve (0.893),1.88 cm was the best cut-off limit with a sensitivity of 100％ and a specificity of 71.43％.Condusions Pelvic ultrasound examination is a valuable tool for the diagnosis and differentiation between CPP,isolated premature thelarche/pubarche /menarche and normal girls. Key words: Ultrasonography; Puberty, precocious

Precocious Puberty and Age Estimation: A Medico-Legal Case Report

To the Editor : As per the Juvenile Justice (Care and Protection of Children) Rules 2007 of India, determination of age can be done by (i) the matriculation or equivalent certificates, (ii) the date of birth certificate from the school (other than a play school) first attended (iii) the birth certificate given by a corporation or a municipal authority or a panchayat and only in the absence of either of above, (iv) the medical opinion will be sought from a duly constituted medical board, which will declare the age of the juvenile or child. While estimating the age of an individual multiple criteria’s such as physical development, dental examination and radiological examination of appearance and fusion of epiphysis of long bones are commonly used. There has been considerable variation regarding the ages at which epiphyseal union occurs with diaphysis of individual bone. Variation could be seen depending on several factors [1]. A girl of low socioeconomic status and from illiterate family of rural background alleged to be of 13 y of age was brought for bone age estimation in a case related to her abduction. Physical appearance of the girl was consistent with the age as alleged. Dental age was between 12–14 y (Second molar was present in all four quadrants). On radiological examination, iliac crest (19 y), medial end of clavicle (22 y) and multiple sternal ossification centres were found fused except 1st and 2nd sternbrae (puberty to 25 y). Therefore, the radiological bone age was found to be between 22–25 y. The discrepancy in the physical/dental age and the bone age was a serious medicolegal challenge. Endocrinology evaluation and ultrasonography did not reveal any significant finding. History given bymother of the victim, revealed that the girl was born in 1998, admitted in the school directly in first standard in 2004, had first menses in 3rd standard (2006) suggestive of age at first menses to be about 8 y. Breast development also started simultaneously. Therefore, the diagnosis of precocious puberty was made. Puberty is said to be precocious if breast budding begins before age 8 or menarche occurs before the age of 9. Ninety percent cases of precocious puberty are of constitutional or idiopathic origin. In these, no cause of premature maturation of the central nervous system-hypothalamic-pituitary axis could be identified [2]. However, further clinical evaluation was suggested but patient did not turn up. Osseous maturation with earlier epiphyseal fusion and short height has been reported in such cases. Dental age and mental development are compatible with chronologic age [3]. This case highlights the importance of detailed history taking and physical developments in an individual while estimating the age of the person for law enforcement.

Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for diagnosis of precocious puberty in Korean girls?

Basal luteinizing hormone and follicular stimulating hormone: is it sufficient for diagnosis of precocious puberty in Korean girls?

A Case of Craniopharyngioma Presenting as Precocious Puberty after a Period of Stunted Growth

A case of craniopharyngioma (CP) presenting as precocious puberty associated with growth acceleration after a period of stunted growth is reported in a 7.5-year-old girl. The girl grew along the 25 th percentile until the age of 4 years, when her height fell down to 3 rd percentile until she was 7 years old. Then, a breast bud occurred, the growth rate increased and a diagnosis of precocious puberty was made. Brain magnetic resonance imaging revealed an oval suprasellar mass pressing and flattening the hypophysis with ventral displacement of the optic chiasm suggesting a CP. No headache or other neurophthalmologic disturbances were documented. After resection of CP, the girl showed panhypopituitarism that was treated with hormonal substitutive therapy. A few months later, the major problem became the exponential increase of the weight due to the hyperphagia not responding to any diet regimen and leading the girl to develop a severe hypothalamic obesity. In fact, at the age of 8.3 years she showed an height of 118.8 cm (-1.53 SDS) and a weight of 37.5 Kg (BMI 2.14 SDS). In conclusion, CP has a wide range of clinical manifestations, depending of the tumour size as well as the extent of endocrine deficiency and the age of the patient. In our patient the initial growth failure was, probably, due to the compressive action of CP. Then, the onset of precocious puberty was related to the stimulating effect of the neoplasia on gonadotropic pituitary cells.

A single sample GnRHa stimulation test in the diagnosis of precocious puberty

ContextGonadotropin-releasing hormone (GnRH) has been the standard test for diagnosing central precocious puberty. Because GnRH is no longer available, GnRH analogues (GnRHa) are now used. Random LH concentration, measured by the third-generation immunochemiluminometric assay, is a useful screening tool for central precocious puberty. However, GnRHa stimulation test should be considered, when a basal LH measurement is inconclusive. However optimal sampling times for luteinizing hormone (LH) have yet to be established.PurposeTo determine the appropriate sampling time for LH post leuprolide challenge.MethodsA retrospective analysis of multi-sample GnRHa stimulation tests performed in 155 children (aged 1–9 years) referred for precocious puberty to Texas Children’s Hospital.After 20 mcg/kg of SQ leuprolide acetate, samples were obtained at 0, 1, 3, and 6 hours.ResultsOf 71 children with clinical evidence of central precocious puberty, fifty nine children had a peak LH >5 mIU/mL. 52 (88%) of these responders had positive responses at 1 hour (95% CI is 80–96%), whereas all 59 children (100%) had a peak LH response >5 mIU/mL at 3 hours (95% CI is 94-100%), P = 0.005.ConclusionsA single serum LH sample collected 3 hours post GnRHa challenge is the optimal sample to establish the diagnosis of central precocious puberty.

Bone mineral density and body composition in girls with idiopathic central precocious puberty before and after treatment with a gonadotropin-releasing hormone agonist

OBJECTIVES:Idiopathic central precocious puberty and its postponement with a (gonadotropin-releasing hormone) GnRH agonist are complex conditions, the final effects of which on bone mass are difficult to define. We evaluated bone mass, body composition, and bone remodeling in two groups of girls with idiopathic central precocious puberty, namely one group that was assessed at diagnosis and a second group that was assessed three years after GnRH agonist treatment.METHODS:The precocious puberty diagnosis and precocious puberty treatment groups consisted of 12 girls matched for age and weight to corresponding control groups of 12 (CD) and 14 (CT) girls, respectively. Bone mineral density and body composition were assessed by dual X-ray absorptiometry. Lumbar spine bone mineral density was estimated after correction for bone age and the mathematical calculation of volumetric bone mineral density. CONEP: CAAE-0311.0.004.000-06.RESULTS:Lumbar spine bone mineral density was slightly increased in individuals diagnosed with precocious puberty compared with controls; however, after correction for bone age, this tendency disappeared (CD = -0.74±0.9 vs. precocious puberty diagnosis = -1.73±1.2). The bone mineral density values of girls in the precocious puberty treatment group did not differ from those observed in the CT group.CONCLUSION:There is an increase in bone mineral density in girls diagnosed with idiopathic central precocious puberty. Our data indicate that the increase in bone mineral density in girls with idiopathic central precocious puberty is insufficient to compensate for the marked advancement in bone age observed at diagnosis. GnRH agonist treatment seems to have no detrimental effect on bone mineral density.

Evaluation of GnRH analogue testing in diagnosis and management of children with pubertal disorders

Context:Gonadotrophin releasing hormone (GnRH) stimulation test is pivotal in the assessment of children with pubertal disorders. However, lack of availability and high cost often result in the test falling into disfavor. We routinely use the GnRH analogue stimulation test as an alternative at our center.Aim:To present the data on children with endocrine disorders who underwent GnRH agonist stimulation test in pediatric endocrine clinic of a tertiary care referral hospital.Setting and Design:Pediatric endocrine clinic of a tertiary care referral hospital. Retrospective analysis of case records.Materials and Methods:The details pertaining to clinical and radiological parameters and hormonal tests were retrieved from case records of 15 children who underwent GnRH agonist stimulation test from May 2010 to April 2011.Results:Indications for testing with GnRH analogue were evaluation of delayed puberty, diagnosis of precocious puberty, assessment of hormonal suppression in treatment of precocious puberty and micropenis in two, nine, three and one cases, respectively. The results of the test and clinical and radiological parameters were in concordance. The test was also crucial in diagnosing the onset of central precocious puberty in two children with congenital adrenal hyperplasia.Conclusion:GnRH agonist test is a convenient, safe test that can be performed on an out-patient basis and can help the clinicians in the correct diagnosis and appropriate treatment of various puberty-related disorders.

Increased Risk of Precocious Puberty in Internationally Adopted Children in Denmark

Increased Risk of Precocious Puberty in Internationally Adopted Children in Denmark

Prevalence and Incidence of Precocious Pubertal Development in Denmark: An Epidemiologic Study Based on National Registries

To our knowledge, no population-based epidemiologic studies on the incidence and prevalence of precocious pubertal development have been published. Danish national registries provide sufficient data for estimating the prevalence and incidence of this condition. The aim of this study was to estimate the prevalence and incidence of precocious pubertal development in Denmark in a 9-year period. The age- and gender-specific incidence rates as well as prevalence rates of precocious pubertal development in Denmark were estimated using data from the Danish National Patient Registry and Statistics Denmark from 1993 to 2001. Overall, 670 children with precocious pubertal development were registered with a diagnosis of precocious puberty (PP) from 1993 to 2001, corresponding to 50 to 70 new cases of PP per year in Denmark. The incidence of PP was constant during the study period from 1993 to 2001. The incidence of PP subdivided by gender and age at diagnosis was approximately 0.5 per 10000 in girls who were younger than 2 years, decreasing to levels below 0.05 per 10000 in girls aged 2 to 4 years, thereafter gradually rising to 8 per 10000 for girls aged 5 to 9 years. For boys who were younger than 8 years, the incidence was very low (<1 per 10000) and increased only slightly to 1 to 2 per 10000 in boys aged 8 to 10 years. The prevalence of PP was approximately 20 to 23 per 10000 in girls, whereas the prevalence was fivefold lower for boys (<5 per 10000). From this first epidemiologic study based on national registries, we estimated that 0.2% of all Danish girls and <0.05% of Danish boys had some form of precocious pubertal development.

Prise en charge des enfants avec puberté précoce centrale

Diagnosis of precocious puberty is defined as the onset of clinical signs of puberty before the age of 8 years in girls and 9 years in boys. The impact of precocious pubertal development on the patients is both physical and psychological. Compromised adult height is a long term potential complication which can be avoided with treatment by GnRH analogues. Patients to be treated are those with precocious physical signs of puberty, significantly advanced bone maturation, predicted height below their target height and a pubertal response to gonadotrophin testing. There is a major subgroup of girls in whom treatment may not be necessary as they show a slowly progressive or stationary pubertal development without deterioration of their predicted height, and achieve their genetically determined height potential without treatment. In these cases, the decision not to treat at the time of initial evaluation is based on the absence of hypothalamo-pituitary ovarian activation or significantly advanced bone maturation.