Puberty In Girls Research Articles

Evaluation of the usefulness of antymüllerian hormone and inhibin B as markers of ovarian activity in patients with Turner syndrome - preliminary results.

Spontaneous puberty occurs in 30% of patients with Turner Syndrome. Its absence is an indication for hormone replacement therapy (HRT). No reliable markers of spontaneous puberty have been defined to date. To evaluate the usefulness of antymüllerian hormone (AMH) and inhibin B assessment in predicting ovarian function and spontaneous puberty in girls with TS. The study included 35 TS patients treated with human recombinant growth hormone (rhGH). Gonadal axis function parameters (LH, FSH and estradiol) were evaluated at the age of physiological puberty (10-12 years, mean 10.5 years), before introduction of HRT. Ad-ditionally AMH and inhibin B levels were assessed. In follow up patients were divided into 2 groups: with (SP) and without (WP) spontaneous puberty. Spontaneous puberty was defined as Tanner stage 2 or higher breast development. WP patients were observed until the mean age of 16y. SP occurred in 16 patients (mean age 10 years). Patients with SP presented with significantly lower mean FSH level (1.14-91.1 mIU/ml, mean mIU/ml 24.5 vs. 7.7-196.4 mIU/ml, mean 66.5 mIU/ml, p = 0.002), higher mean estradiol (10.5-68.8 pg/ml, mean 28.4 pg/ml vs. 6.1-26.0 pg/ml, mean 14.9 pg/ml, p = 0.005), AMH (0.0-3.11 ng/ml, mean 0.8 ng/ml vs. 0.0-0.002 ng/ml, mean 0.003 ng/ml, p = 0.001) and inhibin B (0.0-110.0 pg/ml, mean 29.1 pg/ml vs. 0.0-11.0 pg/ml, mean 1.06 pg/ml, p = 0.026) levels. In three SP patients without elevated FSH level (FSH < 35 mIU/ml) we found zero concen-tration levels of AMH and inhibin B. SP patients had mosaic (non 45,X) karyotype in 87.5% and WP patients only in 47%. AMH and inhibin B assessment may be a valuable complement to the diagnosis of ovarian function in patients with TS. Low levels of these parameters may indicate a risk of ovarian failure even in patients with spontaneous puberty and without hypergonadotropic hy-pogonadism.

Acupuncture Improving Early Sexual Development of Girls with Peripheral Precocious Puberty: A Prospective Cohort Study.

Objective To study primarily on the effect of acupuncture on breast Tanner stage, serum sex hormone level, and TCM symptom scores in girls with peripheral precocious puberty (PPP). Methods 19 eligible patients diagnosed with PPP received acupuncture intervention for 12 weeks, twice a week for 12 weeks, 24 sessions of acupuncture treatment in all, and then follow-up for 12 weeks. The primary outcome was the change in serum luteinizing hormone (LH) level, follicle-stimulating hormone (FSH) level, and breast Tanner stage at 12-week treatment and 12-week follow-up. Serum estradiol (E2) level and TCM symptom scores were also assessed. Results Nineteen patients with peripheral precocious puberty were treated with acupuncture. After the 12-week acupuncture intervention, the serum LH level, breast Tanner stage, and TCM symptom scores decreased significantly compared with baseline (P < 0.05); the serum FSH and E2 level did not change significantly after the 12-week treatment (P > 0.05). After the 12-week follow-up, breast Tanner stage and TCM symptom scores decreased significantly compared with baseline (P < 0.05), and there was no statistical difference between serum sex hormone (LH, FSH, and E2) level and baseline level (P > 0.05). During the period of acupuncture treatment, no side effects or serious adverse events occurred. Conclusions Acupuncture is effective in regulating the hormone level and controlling early development process. It may be a viable alternative to the treatment of peripheral precocious puberty in girls. However, further randomized controlled trials are needed.

Juvenile granulosa cell tumor of the ovary in a 7-year-old girl: Rare case report

Ovarian granulosa cell tumor (GCT) is a rare ovarian neoplasm, which typically occurs in children and young women. More than 90% of the patients are diagnosed in Stage IA, who can be cured by unilateral oophorectomy. Meanwhile, the remaining is diagnosed in more advanced stages, wherein tumors may exhibit aggressive behavior. In this stage, surgery and adjuvant chemotherapy may be required. Isosexual precocious puberty in girls is mostly idiopathic in origin. However, this is a diagnosis of exclusion, and many differential diagnoses have to be thought of in evaluation of precocity in girls. We are presenting here a case of isosexual precocity in a 7-year-old girl due to juvenile GCT of ovary, a rare etiology of precocity.

Sex and age-related changes in L-arginine metabolism in peripheral blood leukocytes in young caucasians with type 1 diabetes mellitus

We found that hyperactivation of cytoplasmic (anti-inflammatory) and mitochondrial (pro-inflammatory) arginase isoforms in peripheral blood leukocytes (PBL) is more pronounced in women than in male patients with type 1 diabetes mellitus (T1DM) who received insulin for one year, especially in adolescents young adults 15 years old (12.0 - 25.0) compared with children/adolescents 9.3 years old (4.5-11.8). Long-term treatment with insulin up to 14 years (on average 5.3-5.9) reduces the activity of arginase, especially in puberty girls with a tendency to normalize mitochondrial arginase, while in prepubertal boys the activity of both arginase isoforms almost doubles and remains elevated in puberty boys and can be involved in inhibiting nitric oxide synthase (NOS) and decreasing the bioavailability of NO. This is confirmed by the concomitant continuous decrease in the levels of nitric oxide synthase (NOS) products, stable metabolites of NO (nitrite) and L-citrulline in the cytoplasm and mitochondria of PBL in prepubertal girls and boys, in the latter, regardless of age and insulin therapy, while in girls of puberty changes not found, apparently, due to the increased level of sex hormones that promote the expression and activity of NOS, which contribute to the inhibition of arginase. Further studies are needed to understand whether sex and age-related changes found in L-arginine metabolism in PBL can be useful in assessing the stage and progression of T1DM and the effectiveness of therapy.

Perceived Effect of Pubertal Developmental Body Changes on Academic Achievement Among Public Primary School Pupils in Sagana, Kirinyaga West Sub-County, Kenya

Pupils in puberty face several challenges that affect their academic achievement. Academic achievement of pupils is also affected as boys and girls in puberty perform dismally. Puberty is a developmental stage for a human being characterized by increased changes in bodies of the young people. The body changes are manifested in emotional, physical and attitude changes that affect their academic performance. During the onset of this period, many young people attending school become affected posing potential risks to optimal academic achievement. The purpose of this study was to determine the perceived effect of pubertal developmental body changes on academic achievement among pupils in Sagana, Kirinyaga West Sub-County, Kenya. This study employed descriptive survey research design that comprises both quantitative and qualitative research procedures used for obtaining information from a large population. The researcher targeted 480 respondents comprising of twelve class teachers and 468 pupils in classes six and seven in six schools. Simple random sampling technique was used to obtain a sample size of 214 pupils from the target population of 468 pupils. The researcher also used purposive technique to obtain a sample of twelve class teachers. The researcher used questionnaires for teachers and pupils as well as achievement records for pupils to collect data. Validity of the instruments was confirmed through expert judgment from the Department of Education at Chuka University. The questionnaires and achievement tests were tested for reliability. Two schools were purposively selected for testing of the instruments using split half method. With a coefficient (α=0.81), the instruments were considered reliable for data analysis. Both qualitative and quantitative data were generated. Computer programme Statistical Package for Social Sciences Version 21 was used to analyse quantitative data that generated frequencies and percentages which were presented in Tables and Graphs. For qualitative data, content analysis was used to arrange data into themes. Findings indicating perceived effect of pubertal developmental body changes on academic achievement were established. Findings indicated that girls are affected more than boys in terms of academic performance. Also, the findings revealed that pubertal physical development changes are manifested differently in boys and girls with girls being affected most. This study concluded that while pubertal physical body changes occur in both boys and girls, the manifestation of the changes is more in girls than boys with boys exhibiting fewer effects. The study recommends that more strategies to help girls manage the pubertal changes should be devised as a means of improving their academic performance. The findings of this study will benefit pupils, teachers, NGOs, Ministry of Education and academicians. Perceived Effect, Academic performance, pubertal body development, body changes, primary school pupil DOI : 10.7176/JEP/10-35-11 Publication date: December 31 st 2019

Application of auxological methods, including dental age estimation, in the assessment of delayed puberty in girls in gynecological practice.

Developmental gynecology uses methods practiced in auxology - the science of human ontogenetic development.An important and jointly used concept in gynecology and auxology is the concept of developmental age, which, unlikecalendar age, is a measure of the biological maturity of the organism, indicating the stage of advancement in the developmentof certain features or body systems. Developmental age assessment methods include: a) morphological (somatic)age - body height and weight, b) secondary sex characteristics - breast in girls, genitalia (penis and testes) in boys, andpubic hair in both sexes, c) bone age - hand and wrist x-ray, and d) dental age. An important marker of developmentalage is also age at menarche, treated as a late indicator of puberty in girls. All of these methods are useful in the context ofassessing regularity and disorders of puberty, such as delayed puberty. The paper discusses developmental age assessmentmethods that can be used to diagnose delayed puberty as well as the causes of delayed puberty in girls. It should be emphasizedthat in assessing the process of physical development of a given individual, the cooperation of specialists in the fieldof developmental gynecology, pediatrics, auxology, dentistry, endocrinology, and dietetics would be the most desirable.

Basal serum luteinising hormone cut-off, and its utility and cost-effectiveness for aiding the diagnosis of the onset of puberty in girls with early stages of breast development.

To determine basal and gonadotrophin-releasing hormone analogue (GnRHa)-stimulated peak luteinising hormone (LH) cut-offs to diagnose onset of early or normal puberty in girls with each Tanner stage of breast (II and III). A retrospective study of 601 girls with breast onset before 8years of age who underwent GnRHa test was conducted. Patients were categorized as CPP and premature thelarche. Each group was divided into two subgroups; Tanner II and III. Cost-effectiveness analysis was performed. In comparison with basal LH cut-off of 0.3IU/L, basal LH cut-off of 0.2IU/L had comparable specificity (Tanner II: 98.0% vs 94.8%, Tanner III: 98.8% vs 93.8%), but greater sensitivity (Tanner II: 28.3% vs 41.7%, Tanner III: 45.2% vs 59.3%). Specificity of basal LH cut-off of 0.2IU/L was not inferior to that of the traditionally used peak LH of 5IU/L. Using basal LH cut-off of 0.2IU/L followed by GnRHa test in girls with negative basal LH was more cost-saving when compared with using the cut-off of 0.3IU/L. Moreover, using basal LH cut-off of 0.2IU/L followed by GnRHa test provided a cost reduction when compared with performing GnRHa test in all patients. Basal serum LH cut-off of 0.2IU/L could be a simple and cost-saving tool for initial diagnosis of onset of early or normal puberty in girls with Tanner II and III before proceeding to GnRH testing.

Chemicals in Personal Care Products Tied to Early Puberty in Girls

Precocious puberty is defined as the onset of menarche before 9 years of age, or the appearance of secondary sex characteristics before 8 years of age. It is associated with many psychosocial disturbances and adverse health outcomes such as: cardiovascular disease, shorter adult stature, an increased risk of type 2 diabetes and breast cancer. There is a general tendency to a progressive decrease in age of reaching puberty, specifically the onset of thelarche and menarche, girls being 10 times more affected than boys. This actual tendency can be explained by the increasing prevalence of childhood obesity and also by increasing environmental exposure to endocrine disruptor chemicals in household and personal care products.Phenols, phthalates, parabens and other compounds, such as polybrominated biphenyls and diethylstilbestrol are associated with precocious onset of puberty in girls, in case of in-utero or peripubertal exposure. These chemicals are frequently found in toothpaste, cosmetics, soups, shampoos, perfumes and other personal care products, interfering with sex hormones and puberty timing. This is why pregnant women should be more aware and avoid products based on these chemicals.

Is there a causal relationship between obesity and puberty?

The onset of puberty in adolescents and whether it is related to obesity is an ongoing topic for debate. Epidemiological cross-sectional and longitudinal studies show a shift towards earlier onset of puberty in girls who are obese; however, the situation is less clear in boys. Boys who are overweight seem to mature earlier, and boys who are obese mature later, than boys at a healthy weight. The underlying mechanisms are not yet fully understood, and whether earlier onset of puberty in obese girls is based on the activation of the hypothalamic-pituitary-gonadal axis is unclear. The most promising link between obesity and puberty is the adipokine leptin and its interaction with the kisspeptin system, which is an important regulator of puberty. However, peripheral action of adipose tissue (eg, via other adipokines, aromatase activity) could also be involved in changes to the onset of puberty. In addition, nutritional factors, epigenetics, or endocrine disrupting chemicals are potential mediators linking the onset of puberty to obesity. This Review summarises our knowledge concerning the relationship between obesity and onset and tempo of puberty, and the consequences of early puberty on obesity.

Central precocious puberty in girls: Diagnostic study and auxological response to triptorelin treatment

IntroductionThere are several controversies regarding the diagnostic tests and management of central precocious puberty (CPP). The aim of this study is to present the experience acquired in a group of girls with CPP treated with triptorelin, and to analyze the auxological characteristics and diagnostic tests. Material and methodsAn observational, retrospective study in a group of 60 girls with CPP was conducted between January 2010 and December 2017. Sociodemographic, auxological and hormonal data were recorded at diagnosis, and pelvic ultrasound and magnetic resonance imaging of the head were performed. Girls were treated with triptorelin and monitored after treatment discontinuation until menarche. ResultsAt treatment start, chronological age and bone age were 7.7±0.7 and 9.7±0.8 years respectively, and growth velocity was 8.3±1.6cm/year. Target height was 161.1±5.8cm. Peak LH level after stimulation was 16.6±12.1IU/l. Ovarian volumes were greater than 3mL in 35% of cases. MRI of the head was pathological in seven girls (11.7%). At treatment completion, chronological age and bone age were 10.3±1.1 and 11.2±0.8 years respectively, and growth velocity was 4.7±1.4cm/year. At the age of menarche (11.9±0.9 years), height was 157.5±5.7cm. ConclusionsTreatment of CPP with triptorelin appears to be beneficial. The possibility to block pubertal development and slow skeletal maturation allows patients to reach their target height. However, individualized auxological monitoring would be mandatory.

Behavioural factors as predictors of self-rated health among polish adolescent girls.

IntroductionSelf-rated health (SRH), an indicator which is extensively used in population studies, constitutes a measure of health closely linked to morbidity, mortality and overall health status and enjoys popularity in surveys monitoring adolescents. Most studies show that at puberty girls assess their health as worse than boys do, and the difference widens with age. Moreover, puberty is a crucial period for health, since it is the time when health risk behaviours are often initiated or become established.AimTo analyse the associations between high scores on self-rated health among 15-year-old girls, participants of the Healthy Me programme, and their selected health behaviours.Material and methodsThe study covered a group of 1173 second-grade female students from 48 lower secondary schools located in rural and urban areas of 16 voivodeships all over Poland. The participants answered questions about chronic diseases or disability, self-rated health, diet, leisure activities, physical activity and health risk behaviours. In the statistical analysis, the association between self-rated health and individual indicators of health behaviour was examined using logistic regression.ResultsTwo thirds of the girls assessed their health as excellent or good. Only approximately 5% of the respondents made the "extreme negative" assessment. In the final multivariate analysis, five factors remained important predictors of high self-rated health scores: regular participation in physical education classes, vigorous physical activity, daily breakfast consumption, consumption of fruit at least once a day and sleep for at least 8 hours a day.ConclusionsRegularparticipation in physical education classes, vigorousphysical activity, consumption of breakfast and fruit every day, as well as sleep for at least 8 hours a day are powerful predictors of high scores on self-rated health of 15-year-old adolescent girls.Public health activities aimed at adolescents should focus on the positive aspects of health and a lifestyle paying special attention on pro health behaviours.

Early-life exposure to endocrine-disrupting chemicals and pubertal development in girls.

Over the last decades, the onset of puberty in girls has occurred earlier, but the tempo of pubertal progression has been relatively slower, resulting in a younger age at puberty onset without a change in age at menarche. Sufficient energy availability and adiposity contribute to early pubertal development, and environmental factors, such as endocrine-disrupting chemicals (EDCs), may affect not only the control of energy balance, but also puberty and reproduction. EDCs are hormonally active substances that can perturb puberty by acting both peripherally on target organs, such as adipose tissue or adrenal glands, and/or centrally on the hypothalamic-pituitary-gonadal (HPG) axis. Depending on whether the exposure takes place earlier during fetal and neonatal life or later during early childhood, EDCs can lead to different outcomes through different mechanisms. Evidence of associations between exposures to EDCs and altered pubertal timing makes it reasonable to support their relationship. However, human epidemiologic data are limited or inconsistent and cannot provide sufficient evidence for a causal relationship between EDC exposure and changes in pubertal timing. Further investigation is warranted to determine the overall or different effects of EDCs exposure during prenatal or childhood windows on pubertal milestones and to reveal the underlying mechanisms, including epigenetic marks, whereby early-life exposure to EDCs affect the HPG-peripheral tissue axis.

Comparative study of GnRHa stimulation test and GnRH stimulation test

Objective To compare the results of GnRHa stimulation test and GnRH stimulation test in girls with Idiopathic central precocious puberty. Methods The girls aged 6-10 who were diagnosed with early breast development(<8 years old) from January 2016 to June 2018 were randomly divided into GnRHa stimulation test group and GnRH stimulation test group according to clinical manifestations, auxiliary examinations and follow-up.The difference in the results of the stimulation test between the two groups was compared. Results A total of 108 girls were enrolled in this study, and 40(37%) of the GnRHa stimulation tests were performed.Among them, 25(63%) patients with idiopathic central precocious puberty had the confirmed diagnosis, and the GnRH stimulation test was performed.Of the 68(63%) patients, 30(44%) had idiopathic central precocious puberty.The peaks of LH in the GnRHa challenge test group and the GnRH challenge test group were 11.33(6.81, 15.79) and 7.89(5.35, 14.21), and the FSH peaks were 15.68(10.18, 20.06) and 17.26(13.34, 21.42), showing no significant differences (U=1078.50, P=0.07; U=1617.50, P=0.10). The peak values of LH/FSH were 0.86(0.37, 1.17) and 0.52(0.31, 0.83), respectively, and there was a statistical difference(U=953.00, P=0.01). GnRH challenge test showed the ICPP sensitivity of 90.91%(81.10%-100.72%), specificity of 94.29%(86.60%-101.98%), total coincidence rate of 92.65%(86.44 %-98.85%), Yoden index of 0.85( 0.72%-0.98%). Sensitivity of the GnRHa challenge test showed the ICPP diagnosis rate of 95.24%(86.13%-104.35%), specificity of 73.68%(53.88%-93.48%), total coincidence rate of 85.00%(73.93%-96.07%), Yoden index of 0.69(0.47-0.91). Conclusion For the diagnosis of idiopathic central precocious puberty in girls, the GnRHa challenge test is more sensitive than the GnRH challenge test, and the specificity and the Yoden index are both low.Therefore, routine use of GnRHa stimulation test as the replacement of GnRH stimulation test is not recommended. Key words: Central precocious puberty; Girl; GnRHa; GnRH; Stimulation test

Роль гиперпролактинемии в генезе преждевременного телархе и ее коррекция у девочек первых пяти лет жизни

Pediatric gynecologists of all types of disorders of sexual development most often diagnose an incomplete form of premature puberty in girls of the isosexual type – isolated thelarche against the background of an elevated prolactin levels. Aim of the research: to study the effect of the drug Cyclodynon® on girls with an isolated thelarche on the background of increased prolactin levels. Materials and methods. Study include 30 girls aged from 1 to 5 years with isolated premature thelarche. Ultrasound and hormonal studies were conducted. All patients were examined by the endocrinologist, neurologist and pediatrician. Girls with isolated thelarche and a high prolactin level were prescribed the drug Cyclodynon® depending on the age and prolactin level at a dose of 1/8 to 1 tablet (or 5 to 40 drops) in the morning on an empty stomach once a day. Results. Study included 30 girls with isolated thelarche revealed a stable increase in the prolactin level (up to 680 mIU/l while normal values is 110–400 mIU/l) with relatively normal gonadotropins and estradiol levels. The use of a special extract of Vitex Agnus Castus Cyclodуnon® contributed to a gradual over 3 months reducing the prolactin level to normal from 680 to 396 mIU/l. Decrease in prolactin level correlated with regression of clinical signs of thelarche. Adverse or desirable effects when Cyclodynon® use for 3 months were noted. Conclusion. Increased prolactin level played significant role in children during the first five years of life in the isolated thelarche genesis. The use of standardized herbal drug Cyclodynon® with dopaminergic effect led to normalization of the prolactin level in treatment girls with isolated thelarche on the background of elevated prolactin levels and is an effective and pathogenetically justified. This is confirmed by the results of clinical and hormonal studies.

183-LB: The Gut Microbiome and Puberty in Girls at Risk for Type 2 Diabetes (T2D)

Objectives: Pediatric-onset T2D is twice as common in girls vs. boys and is tightly linked with puberty and obesity. Alterations in gut microbiota, specifically the Firmicutes:Bacteroidetes ratio (F:B), may be associated with insulin sensitivity (Si) and may play a role in the pathophysiology of T2D. We aimed to evaluate associations between gut microbiome composition and Si and insulin secretion in obese prepubertal (PP) vs. late-pubertal (LP) girls. Methods: Obese PP (N=9, age 8.5 ±0.8 year, BMIz 2.0±0.5) and LP (Tanner 4-5, N=9, age 13.0±2.0 year, BMIz 2.0±0.5) obese girls underwent stool collection and intravenous glucose tolerance testing after an overnight fast. High-throughput sequencing of the bacterial 16S rRNA gene V3-V4 region was used to profile fecal bacterial communities. Bergman's minimal model was used to estimate Si and insulin secretion (acute insulin response to glucose, AIRg) and disposition index (DI). T-tests assessed group differences in Si, AIRg and DI. Spearman’s correlation examined relationships between microbiota relative abundance (%RA) and Si, AIRg and DI. Results: PP vs. LP girls had significantly higher Si (8.0±1.0 vs. 2.0±0.5 x10-4/min-1/μIU/ml, p&amp;lt;0.001) and DI (3,525 ± 636 vs. 1,687 ± 385 x10-4/min-1, p=0.03). AIRg was not different between PP and LP girls (568 ± 132 vs. 840 ± 174 μIU/ml, p=0.23). F:B ratio related to insulin secretion and DI, (r=-0.32, p=0.20; r=-0.39, p=0.11) but not Si. At the genus level, Si was correlated to Ruminococus and Lachnospira %RA (r=0.53, p=0.02; r=0.50, p=0.036). AIRg was correlated to Peptostreptococcaceae %RA (r=-0.48, p=0.045). DI was correlated with Prevotella and Bifidobacterium %RA (r=0.57, p=0.01; R=- 0.54, p=0.02). Conclusion: These pilot study results suggest possible relationships among the gut microbiome, glucose metabolism, and puberty in girls at risk for T2D that merit further exploration. Disclosure B. Jobira: None. D.N. Frank: None. L. Pyle: None. S. Gross: None. D. Ir: None. W. Pendleton: None. C.E. Robertson: None. K.J. Nadeau: None. M.M. Kelsey: None. Funding University of Colorado Center for Women’s Health; National Institutes of Health/Colorado Clinical Translational Science Award (UL1TR002535)

Update on Precocious Puberty in Girls.

Precocious puberty (PP) in girls refers to secondary sexual development occurring earlier than the lower end of normal for the onset of puberty. It might be the presenting feature of a serious underlying condition or signify a common variation of normal for which no treatment is necessary. Depending on the source and type of sex steroids involved, clinical findings may indicate exposure to estrogens, androgens, or both. Likewise, the onset of the PP might be gradual or abrupt and the rate of progression is variable. Recent years have witnessed exciting advancements in the understanding of the molecular genetic basis for some forms of PP in girls as well as in the development of additional treatment options. In this review an update on the most commonly encountered causes of PP in girls including their clinical presentation, pathophysiology, diagnosis, and management are provided. Recommendations regarding when to refer, and areas in particular need of additional research are also delineated.

Heterogeneity in childhood body mass trajectories in relation to prenatal phthalate exposure

Phthalates, compounds commonly used in plastics and personal care products, have been associated with childhood obesity in cross-sectional and some longitudinal studies. Using advanced statistical methods, we characterized the heterogeneity in body mass development patterns over childhood (ages 2–14 years) and explored associations with maternal prenatal urinary concentrations of phthalates among 335 children in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) cohort study. Height and weight were measured every one to two years in this cohort, which had a high prevalence of obesity and overweight. Building upon a previous analysis that showed a positive association between prenatal phthalate exposure and body mass index (BMI) in CHAMACOS children, we used three advanced statistical methods: generalized additive models, growth mixture models, and functional principal component analysis with tree-based methods to identify patterns of childhood BMI development and allow for non-linear relationships with the environmental exposures. Our results highlight the heterogeneity in childhood BMI development patterns and suggest a sex-specific non-linear association between prenatal monoethyl phthalate urinary concentrations and BMI level in children, confirmed across a variety of statistical methods. There is also evidence to suggest positive associations between DEHP metabolites and BMI stabilization during puberty for girls.

Precocious puberty in girls in Qazvin, Iran from 2006-2018

Precocious puberty in girls in Qazvin, Iran from 2006-2018

Gynecologic and reproductive outcomes in fibrous dysplasia/McCune-Albright syndrome

BackgroundAutonomous ovarian activation with recurrent estrogen-producing cysts is a hallmark feature of the rare bone and endocrine disorder fibrous dysplasia/McCune-Albright syndrome. Precocious puberty in girls with McCune-Albright syndrome has been well-described, however long-term effects on gynecologic and reproductive function are unknown. Concerningly, case reports have described poor skeletal outcomes associated with pregnancy in women with fibrous dysplasia.MethodsThirty-nine women with fibrous dysplasia/McCune-Albright syndrome were evaluated as part of a natural history study. Clinical, radiographic, and biochemical data were reviewed. Women were contacted to obtain detailed menstrual and reproductive histories.ResultsAbnormal uterine bleeding affected 77% of women (30/39), and was associated with severe anemia requiring blood transfusion in 3 cases. Nine women underwent hysterectomy for management of bleeding, including 67% (6/9) at the unusually young age of less than age 35 years. Infertility affected 43% of women (9/21), including 2 women who developed primary ovarian insufficiency after undergoing surgical treatment of ovarian cysts. Of 25 spontaneous pregnancies in 14 women, 35% (8) were unplanned. Among the 14 pregnancies, pregnancy was associated with no change in bone pain in 7 subjects (53%), increased bone pain in 4 subjects (31%), and decreased bone pain in 2 subjects (15%). No additional skeletal complications were reported during pregnancies.ConclusionsWomen with fibrous dysplasia/McCune-Albright syndrome report a high prevalence of gynecologic morbidity and reduced fertility. There is no clear association between pregnancy and poor skeletal outcomes in this population.

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