Mechanism Of Precocious Puberty Research Articles

Hypomelanosis of Ito Associated With Precocious Puberty

Hypomelanosis of Ito has been associated with precocious puberty in two cases. This study reports a third case involving a female with hypomelanosis of Ito including severe mental retardation and seizure disorder with autonomic symptoms (gastroesophageal reflux and asthma). At age 5 she developed vaginal discharge, thelarche, and adrenarche. Soon after, she died of pneumonia stemming from her neurologic deficits. A postmortem examination revealed normal gonads and endocrine organs. The breasts and vulva were prematurely developed. Central nervous system findings included megalencephaly, neuronal eosinophilic inclusions, leptomeningeal neuroglial heterotopias, and cortical dysplasia. Both previously reported cases of hypomelanosis of Ito associated with precocious puberty had abnormal gonads and responded to cyproterone acetate therapy, indicating a peripheral mechanism of precocious puberty (gonadotrophin-independent). The current case, which was autopsied, lacks significant gonadal pathology, and has extensive neurologic involvement that suggests that a central mechanism of precocious puberty (gonadotrophin-dependent) can also be associated with hypomelanosis of Ito.

Sexual precocity after immigration from developing countries to Belgium: evidence of previous exposure to organochlorine pesticides

In a retrospective auxological study of 145 patients seen in Belgium during a 9‐year period for treatment of precocious puberty, 28% appeared to be foreign children (39 girls, one boy) who immigrated 4 to 5 years earlier from 22 developing countries, without any link to a particular ethnic or country background. The patients were either adopted (n = 28) or non‐adopted (n = 12), the latter having normal weight and height at immigration and starting early puberty without evidence of earlier deprivation. This led to the hypothesis that the mechanism of precocious puberty might involve previous exposure to oestrogenic endocrine disrupters. A toxicological plasma screening for eight pesticides detected p, p'‐DDE, which is derived from the organochlorine pesticide DDT. Median p, p'‐DDE concentrations were respectively 1.20 and 1.04 ng/ml in foreign adopted (n = 15) and non‐adopted (n = 11) girls with precocious puberty, while 13 out of 15 Belgian native girls with idiopathic or organic precocious puberty showed undetectable concentrations (<0.1 ng/ml). A possible relationship between transient exposure to endocrine disrupters and sexual precocity is suggested, and deserves further studies in immigrant children with non‐advanced puberty.

Sexual precocity after immigration from developing countries to Belgium: evidence of previous exposure to organochlorine pesticides.

In a retrospective auxological study of 145 patients seen in Belgium during a 9-year period for treatment of precocious puberty, 28% appeared to be foreign children (39 girls, one boy) who immigrated 4 to 5 years earlier from 22 developing countries, without any link to a particular ethnic or country background. The patients were either adopted (n = 28) or non-adopted (n = 12), the latter having normal weight and height at immigration and starting early puberty without evidence of earlier deprivation. This led to the hypothesis that the mechanism of precocious puberty might involve previous exposure to oestrogenic endocrine disrupters. A toxicological plasma screening for eight pesticides detected p,p'-DDE, which is derived from the organochlorine pesticide DDT. Median p,p'-DDE concentrations were respectively 1.20 and 1.04 ng/ml in foreign adopted (n = 15) and non-adopted (n = 11) girls with precocious puberty, while 13 out of 15 Belgian native girls with idiopathic or organic precocious puberty showed undetectable concentrations (<0.1 ng/ml). A possible relationship between transient exposure to endocrine disrupters and sexual precocity is suggested, and deserves further studies in immigrant children with non-advanced puberty.

Luteinizing-Hormone-Mediated Precocious Puberty Induced in Female Rats by a Prepuberal Pituitary Graft

The present study analyzes the mechanism of precocious puberty induced in female rats after a 'young' pituitary graft (obtained from 21-day-old animals). For this purpose, the following experiments have been performed: (1) female rats were grafted or sham-operated on day 21 with a littermate's pituitary the follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol plasma levels as well as the ovarian, uterine and adrenal weights were determined at different times after the graft; (2) female rats grafted or sham-operated on day 21 were treated with 0.2 ml of LH antiserum (LHAS) or the same volume of a normal horse serum (NHS); (3) female rats were injected on day 1 of life with 0.1 mg of estradiol benzoate or olive oil. Groups of these animals were decapitated daily between days 6 and 21 in order to measure gonadotropins and prolactin (PRL) pituitary content. Since on day 21 estrogenized females showed decreased gonadotropin content and normal PRL content, females in experiment 4 were grafted on day 21 with pituitaries obtained from control or neonatally estrogenized female rats. The results obtained showed that FSH, LH and estradiol plasma levels as well as ovarian and uterine weights increased after pituitary grafts. LHAS blocked the precocious puberty induced by the pituitary graft, and pituitaries obtained from neonatally estrogenized female rats were unable to modify the occurrence of puberty when grafted. In conclusion, this work evidences that precocious puberty induced by 'young' pituitary grafts was mediated by the increase in LH secretion from the graft.

Variable response to a long-acting agonist of luteinizing hormone-releasing hormone in girls with McCune-Albright syndrome.

Six girls with McCune-Albright syndrome were treated for at least 2 months with the long-acting LHRH agonist D-Trp6-Pro9-NEt-LHRH, which previously was found to be an effective treatment for true precocious puberty. Nocturnal and LHRH-stimulated serum gonadotropin levels and plasma estradiol levels were measured before treatment and after 2-3 months of treatment. Five of the six girls had no decrease in serum gonadotropin or plasma estradiol levels during therapy, and their pubertal signs were unaffected by treatment. All five of these girls had serum gonadotropin levels that were within or below the normal prepubertal range. The sixth girl, who had gonadotropin levels in the normal pubertal range before treatment, had decreased serum gonadotropin and plasma estradiol levels during 1 yr of LHRH analog therapy. This was associated with cessation of menses and regression of secondary sexual changes. The failure of LHRH analog to modify the course of precocious puberty in the five patients with prepubertal serum gonadotropin concentrations is further evidence that the mechanism of precocious puberty in most girls with McCune-Albright syndrome differs from that in patients with true precocious puberty.

MECHANISM OF PRECOCIOUS PUBERTY IN GIRLS WITH McCUNE-ALBRIGHT SYNDROME (MAS)

We studied 7 girls, ages 1.3 to 10 yrs., with precocious puberty associated with MAS. In 6 of the 7 girls, basal and LHRH-stimulated gonadotropins and bioactive LH were prepubertal. In one girl, gonadotropins and bioactive LH were in the pubertal range. Ovarian volumes (mean 6.4, range 1.4 - 12.9 ml) were increased in all 7 girls compared to prepubertal girls (nl < 0.9 ml - Radiology 125:477(1977)). The girls with MAS had greater asymmetry in ovarian volume than did girls with true precocious puberty (TPP) (R to L difference 5.9 ± 1.9 ml vs. 1.5 ± 0.2 ml in TPP; p<0.05). The logarithm of plasma estradiol correlated significantly with ovarian volume (p< 0.05). Ovarian volumes and plasma estradiol fluctuated markedly over time. LHRH-analog treatment, given to 6 of the 7 girls, failed to suppress menses, ovarian cyst volume, or estradiol levels in the five girls who had low gonadotropins. The girl who had true puberty responded to LHRH-analog treatment. She had a bone age of 13.5 years, which is within the range when puberty normally occurs. Thus, we cannot exclude the possibility that her gonadotropins were also low when secondary sex characteristics first appeared. We conclude that the mechanism of precocious puberty in the majority of girls with MAS is intermittent ovarian estrogen secretion independent of pubertal hypothalamic-pituitary activation.