Pubic Hair Development Research Articles

Reliability of self-reported pubertal development scale for girls in early adolescent: a school population-based study.

The study aimed to evaluate the correlation between self-reported pubertal developmental scale (PDS) and physically assessed Tanner staging by an experienced pediatrician among girls. In a school population-based study in Zhongshan, China, we recruited 1,722 girls in grades 1-3 by a multistage stratified cluster random sampling method. Participants completed self-reported PDS questionnaire prior to physical examination. Breast development was evaluated by a female pediatrician combined with ultrasound examination for overweight/obese girls; pubic hair development was evaluated. Otherwise, we tested follicle-stimulating hormone (FSH) and luteinizing hormone (LH) for some participants. We observed a weak association between Tanner-derived composite stage (TDCS) and puberty category scores (PCS) (τ=0.288, p<0.001) among all girls. There was correlation (τ=0.314, p=0.001) between ultrasound-derived composite stage (UDCS) and PCS among overweight/obese girls. Moreover, among overweight/obese girls, PCS was positively correlated with LH (r=0.265, p=0.008), but not FSH (r=0.155, p=0.123), and when the basal LH value was greater than 0.3 mIU/mL, the proportion of PCS stage≥2 (9/18) was higher than the proportion of TDCS≥2 (5/18). As for the determination of pubertal onset, when UDCS was used as the gold standard, the specificity of PCS was 0.86 and positive predictive value was 90.00 %. There was a weak correlation between PCS and TDCS among girls early adolescence. Moreover, among overweight/obese girls, combining hormone values, ultrasonographic stage of breast, and the positive predictive value of PCS, we posit that self-reported PDS might be a more reliable method than TDCS to evaluate pubertal development among overweight/obese girls.

Exposure to Per- and Polyfluoroalkyl Substances and Timing of Puberty in Norwegian Boys: Data from the Bergen Growth Study 2.

Per- and polyfluoroalkyl substances (PFAS) are widespread environmental contaminants with endocrine-disruptive properties. Their impact on puberty in boys is unclear. In this cross-sectional study, we investigated the association between PFAS exposure and pubertal timing in 300 Norwegian boys (9-16 years), enrolled in the Bergen Growth Study 2 during 2016. We measured 19 PFAS in serum samples and used objective pubertal markers, including ultrasound-measured testicular volume (USTV), Tanner staging of pubic hair development, and serum levels of testosterone, luteinizing hormone, and follicle-stimulating hormone. In addition to logistic regression of single pollutants and the sum of PFAS, Bayesian and elastic net regression were used to estimate the contribution of the individual PFAS. Higher levels of the sum of perfluorooctanesulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorohexanesulfonic acid (PFHxS) were associated with later pubertal onset according to USTV (age-adjusted odds ratio (AOR): 2.20, 95% confidence interval (CI): 1.29, 3.93) and testosterone level (AOR: 2.35, 95% CI: 1.34, 4.36). Bayesian modeling showed that higher levels of PFNA and PFHxS were associated with later pubertal onset by USTV, while higher levels of PFNA and perfluoroundecanoic acid (PFUnDA) were associated with later pubertal onset by testosterone level. Our findings indicate that certain PFAS were associated with delay in male pubertal onset.

HUBUNGAN PEER GROUP SUPPORT DENGAN CITRA TUBUH PADA REMAJA DI SMAN 1 BESUKI

A teenager is someone who experiences a period of behavioral change, both psychological and developmental. Adolescents are a vulnerable population aged 10-19 years (WHO, 2014). Physical changes experienced by adolescent boys and girls include the development of pubic hair, increasing voice, etc. . The aim of this research is to determine the relationship between peer group support and body image in adolescents at SMAN 1 Besuki. This research design uses a correlation design with a cross sectional approach. The population of this study was 154 respondents. The sampling technique uses random sampling. The data collection technique uses a questionnaire. The research found that peer group support with low support had a value of 32 (88.9%), the majority had adequate body image, peer group support with moderate support had a value of 59 (51.8%) the majority had adequate body image, peer group support with high support. The majority of those with a score of 4 (100.0%) have a good body image. The statistical test results show p value = 0.00 &lt; 0.05 using the Spearman Rank Rho' test. These results mean that H1 is accepted with a correlation coefficient (r) = 0.434, which shows that there is a significant relationship between peer group support and body image in teenagers at SMAN 1 Besuki. Teenagers who have a negative self-image make them experience many problems with themselves. The existence of peers among teenagers is very important. Because good peer acceptance will create positive behavior. Teenagers should never feel insecure about themselves so as to increase their positive feelings about their appearance. As peers, we must support and support each other.

Study of rs7759938, rs314280, and rs314276 Polymorphisms of LIN28B in Relation to Age at Menarche in Girls of Greek Descent.

Single-nucleotide polymorphisms in LIN28B, critical regulators of female growth and puberty, have been linked to age at menarche. We assessed the association of rs7759938, rs314280, and rs314276 with menarcheal age in girls of Greek descent. We reviewed the records of 248 girls who had their first menstruation before 18 years and who attended the Greek Departments of Pediatric Endocrinology from January 2021 to July 2023. Genotyping was performed by standard DNA-based methods. Association analyses involved both parametric and non-parametric tests. The average age of breast and pubic hair development was 9.95 years, and the age at menarche was 11.55 years. Menarche occurred ≤11 years (mean 10.24 years) in 108 girls (43.5%) and >11 years (mean 12.55 years) in 140 (56.5%). The girls' menarcheal age correlated significantly with that of their mothers (average 12.1 years, p-value < 0.0001, Spearman's r 0.350). The dominant rs7759938(TT) genotype was the most common (55.2%), followed by the dominant rs314276(CC) (53.2%) and dominant rs314280(TT) (14.5%) genotypes. There was no association between age at menarche and any of the polymorphism genotypes/alleles or between genotypes/alleles and birth weight, gestational week, mode of delivery, and maternal age at menarche. Future large sample studies are warranted to confirm these results.

Validity of self-assessment pubertal Tanner stages by realistic color images and Pubertal Development Scale in a longitudinal cohort study.

To date, the reliability of pubertal development self-assessment tools is questioned, and very few studies have explored the comparison between these tools in longitudinal studies. Hence, this study aimed to examine the reliability of pubertal development self-assessment using realistic color images (RCIs) and the Pubertal Development Scale (PDS) in a longitudinal cohort study. Our longitudinal study recruited 1,429 participants (695 boys and 734 girls), aged 5.8-12.2 years old, in Chongqing, China. We conducted two surveys, 6 months apart. Tanner stages were examined by trained medical students at each visit. RCIs and PDS scores were used to self-assess puberty at each visit. Agreement between physical examination and self-assessment was determined using weighted kappa (wk), accuracy, and Kendall rank correlation. The concordance of puberty self-assessment using RCIs at baseline and the first follow-up was almost perfect in girls and boys, wk >0.800 (p < 0.001). At baseline, the concordance of genital development self-assessment using RCIs was fair in boys, wk = 0.285 (p < 0.001), and that of boys' pubic hair development self-assessment using RCIs was poor, wk = 0.311 [95% confidence interval (CI) -0.157 to 0.818]. The wk of the PDS was less than 0.300, except for breast development. The reliability and validity of the PDS in this study population were low, and the consistency of the PDS was not good. The concordance of RCIs is better than that of the PDS. Pubertal development self-assessment using RCIs is reliable, while the reliability and validity of the PDS are unacceptable. Therefore, RCIs are recommended as a reliable pubertal development self-assessment tool to measure pubertal development for large-scale epidemiological investigations and long-term longitudinal studies in China.

Maternal exposure to polycyclic aromatic hydrocarbons during pregnancy and timing of pubertal onset in a longitudinal mother–child cohort in rural Bangladesh

BackgroundIn experimental studies, several polycyclic aromatic hydrocarbons (PAHs) have shown endocrine disrupting properties, but very few epidemiological studies have examined their impact on pubertal development and results have been heterogenous. ObjectiveTo explore if maternal PAH exposure during pregnancy was associated with the offspring’s timing of pubertal onset. MethodsWe studied 582 mother-daughter dyads originating from a population-based cohort in a rural setting in Bangladesh. Maternal urinary samples, collected in early pregnancy (on average, gestational week 8), were analyzed for monohydroxylated metabolites of phenanthrene (1-OH-Phe, Σ2-,3-OH-Phe, and 4-OH-Phe), fluorene (Σ2-,3-OH-Flu), and pyrene (1-OH-Pyr) using liquid chromatography with tandem mass spectrometry (LC-MS/MS). The girls were interviewed on two separate occasions concerning date of menarche, as well as breast and pubic hair development according to Tanner. Associations were assessed using Kaplan-Meier analysis and multivariable-adjusted Cox proportional hazards regression or ordered logistic regression. ResultsIn early pregnancy, the mothers’ median urinary concentrations of Σ1-,2-,3-,4-OH-Phe, Σ2-,3-OH-Flu, and 1-OH-Pyr were 3.25 ng/mL, 2.0 ng/mL, and 2.3 ng/mL respectively. At the second follow-up, 78 % of the girls had reached menarche, and the median age of menarche was 12.7 ± 0.81 years. Girls whose mothers belonged to the second and third quintiles of ΣOH-Phe metabolites had a higher rate of menarche, indicating a younger menarcheal age (HR 1.39; 95 % CI 1.04, 1.86, and HR 1.41; 95 % CI 1.05, 1.88, respectively), than girls of mothers in the lowest quintile. This trend was not observed in relation to either breast or pubic hair development. None of the other maternal urinary PAH metabolites or the sum of all thereof in early pregnancy were associated with age at menarche or pubertal stage. ConclusionsIndications of non-monotonic associations of prenatal phenanthrene exposure with the daughters’ age of menarche were found, warranting further investigation.

Maternal stress in pregnancy and pubertal timing in girls and boys: a cohort study

To investigate whether maternal stress in pregnancy is associated with pubertal timing in girls and boys and to explore potential mediation by childhood body mass index (BMI) and childhood psychosocial stress. Cohort study. Not applicable. In total, 14,702 girls and boys from the Puberty Cohort, nested within the Danish National Birth Cohort. Maternal stress was obtained from a computer-assisted telephone interview in gestational weeks 30-32 as maternal life stress and emotional distress in pregnancy using questions on the basis of validated screening tools. Maternal life stress and emotional distress in pregnancy were analyzed separately and in an interaction analysis. Pubertal timing was measured half-yearly from age 11 years and throughout pubertal development and assessed as Tanner stages 1-5 (breast and pubic hair development in girls and genital and pubic hair development in boys), menarche in girls, voice break and first ejaculation in boys, and occurrence of acne and axillary hair in both girls and boys. A combined estimate for overall pubertal timing was derived using Huber-White robust variance estimation. Mean differences in age at attaining the pubertal milestones according to prenatal exposure to no (reference), low-, moderate-, or high-maternal stress in pregnancy were estimated using a multivariable censored regression model. Potential mediation by childhood BMI and childhood psychosocial stress was investigated in separate models. After adjustment for potential confounding factors, prenatal exposure to high-maternal life stress (combined estimate: -1.8 months [95% CI, -2.7 to -0.8] and -0.9 months [95% CI, -1.8 to 0.0]), high maternal emotional distress (combined estimate: -1.5 months [95% CI, -2.5 to -0.5] and -1.7 months [95% CI, -2.8 to -0.7]), and both high-maternal life stress and emotional distress (combined estimate: -2.8 months [95% CI, -4.2, to -1.4] and -1.7 months [95% CI, -3.1 to -0.2]) were associated with earlier pubertal timing in girls and boys, respectively. The associations were not mediated by childhood BMI or childhood psychosocial stress. Prenatal exposure to maternal stress in pregnancy was associated with earlier pubertal timing in girls and boys in a dose-dependent manner. The associations were not mediated by childhood BMI or childhood psychosocial stress.

PRECOCIOUS PUBERTY: EPIDEMIOLOGY, CLINICAL PRESENTATION, DIAGNOSIS, AND ETIOLOGIES

Precocious puberty, defined as the onset of sexual characteristics before the age of 8 in girls and 9 in boys, can arise from various causes, including central and peripheral mechanisms. While central precocious puberty (CPP) originates from premature activation of the hypothalamic-pituitary axis, peripheral precocious puberty (PPP) results from gonadal or adrenal hormone secretion independent of hypothalamic control. We conducted a retrospective study spanning eight years, from 2015 to 2023, at the Mohamed 6 University Hospital in Marrakech, Morocco, to investigate the epidemiological, clinical findings, laboratory, and etiological aspects of precociuos puberty in 12 children. We found a predominance of CPP, particularly in girls, with breast development being the most common clinical sign. In boys, early puberty typically presented with pubic hair development and increased penile size. Diagnostic evaluation included hormonal assays and imaging studies, with elevated levels of gonadal hormones confirming the diagnosis. CPP was predominantly idiopathic in girls, while traumatic brain injury and CNS lesions were common causes in boys. Adrenal disorders, including congenital adrenal hyperplasia, accounted for PPP cases. Brain imaging was crucial for identifying central lesions, while adrenal imaging aided in diagnosing adrenal pathologies. Despite limitations such as retrospective design and incomplete data, our study emphasizes the importance of early recognition and appropriate diagnostic procedures for children showing signs of early puberty to optimize management and outcomes.

Pubertal Timing Across Asian American, Native Hawaiian, and Pacific Islander Subgroups

Earlier puberty is associated with adverse health outcomes, such as mental health issues in adolescence and cardiometabolic diseases in adulthood. Despite rapid growth of the Asian American, Native Hawaiian, and Pacific Islander populations in the US, limited research exists on their pubertal timing, potentially masking health disparities. To examine pubertal timing among Asian American, Native Hawaiian, and Pacific Islander children and adolescents by disaggregating ethnic subgroups. This retrospective cohort study included Asian American, Native Hawaiian, and Pacific Islander youths aged 5 to 18 years assessed for pubertal development at Kaiser Permanente Northern California, a large, integrated health care delivery system. Follow-up occurred from March 2005, through December 31, 2019. Data were analyzed in October 2023. Race and ethnicity, categorized into 11 ethnic subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Native Hawaiian and Pacific Islander, Other South Asian, Other Southeast Asian, Vietnamese, multiethnic, and multiracial. Pubertal timing was determined using physician-assessed sexual maturity ratings (SMRs). Outcomes included the median age at transition from SMR 1 (prepubertal) to SMR 2 or higher (pubertal) for onset of genital development (gonadarche) in boys, breast development (thelarche) in girls, and pubic hair development (pubarche) in both boys and girls. In this cohort of 107 325 Asian American, Native Hawaiian, and Pacific Islander children and adolescents (54.61% boys; 12.96% Asian Indian, 22.24% Chinese, 26.46% Filipino, 1.80% Japanese, 1.66% Korean, 1.96% Native Hawaiian and Pacific Islander, 0.86% Other South Asian, 3.26% Other Southeast Asian, 5.99% Vietnamese, 0.74% multiethnic, and 22.05% multiracial), the overall median ages for girls' pubarche and thelarche were 10.98 years (95% CI, 10.96-11.01 years) and 10.13 years (95% CI, 10.11-10.15 years), respectively. For boys' pubarche and gonadarche, median ages were 12.08 years (95% CI, 12.06-12.10 years) and 11.54 years (95% CI, 11.52-11.56 years), respectively. Differences between subgroups with earliest and latest median age at onset were 14 months for girls' pubarche, 8 months for thelarche, 8 months for boys' pubarche, and 4 months for gonadarche. In general, Asian Indian, Native Hawaiian and Pacific Islander, and Other South Asian subgroups had the earliest ages at onset across pubertal markers, while East Asian youths exhibited the latest onset. Restricting to those with healthy body mass index did not substantially change the findings. In this cohort study of Asian American, Native Hawaiian, and Pacific Islander children and adolescents, pubertal timing varied considerably across ethnic subgroups. Further investigation is warranted to assess whether these differences contribute to observed health disparities in adulthood, such as type 2 diabetes and cardiovascular diseases.

Current status of pubertal sexual characteristics development of 2 704 girls aged 6-18 years in Tongzhou District of Beijing

Objective: To understand the current status of pubertal sexual characteristics development of girls aged 6-18 years in Tongzhou District of Beijing and to compare the differences in sexual characteristics development among girls characterized as thin, normal, overweight, and obese. Methods: A cross-sectional survey was conducted among 2 844 girls aged 6-18 years in Tongzhou District of Beijing from September 2022 to July 2023. The developmental stages of breast and pubic hair were assessed on site, and menarche status was inquired. Weight and height were measured. The girls were subsequently characterized into thin, normal, overweight and obese groups. Basic information (including family and personal history) was obtained through questionnaires. Probit probability unit regression was applied to calculate the age of each Tanner stage of sexual characteristics development and the age of menarche. The χ2 test was applied to compare the counting data between two or multiple groups. Results: A total of 2 844 girls were surveyed and 2 704 girls met the inclusion criteria, resulting in a valid response rate of 95.1%. Among these girls, 1 105 (40.9%) were aged 6-9 years, 1 053 (38.9%) were aged 10-13 years, and 546 (20.2%) were aged 14-18 years. The of height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and body mass index-for-age Z-score (BAZ) were 0.46(-0.23,1.16), 0.69(-0.16,1.67), and 0.67(-0.27,1.73) respectively. The prevalences of thin, overweight, and obesity were respectively 1.7% (45/2 704), 17.3% (467/2 704), and 19.9% (538/2 704), respectively. There were 45 girls in the thin group, 1 654 girls in the normal weight group, 1 005 girls in the overweight and obesity group. The age of Tanner stage breast 2 (B2), Tanner stage pubic hair 2 (P2), and menarche was 9.0 (95%CI 8.9-9.1), 10.5 (95%CI 10.4-10.6), and 11.4 (95%CI 11.3-1.5) years, respectively. The current status of breast and pubic hair maturity in girls with pubertal development shows that 64.6% (1 211/1 874) of these girls had breast development preceding pubic hair development, 32.4% (607/1 874) had concurrent breast and pubic hair development, and 3.0% (56/1 874) had pubic hairs development preceding breast development. The interval age between B2 and B5 was 4.7 (95%CI 4.6-4.8) years, between P2 and P5 was 4.5 (95%CI 4.4-4.6) years, and between B2 and menarche was 2.4 (95%CI 2.3-2.5) years. The ages of sexual characteristics development in overweight and obese groups were earlier than that in normal and thin groups. The ages of B2 in thin, normal, overweight, and obese groups were 10.0 (95%CI 9.5-10.6), 9.3 (95%CI 9.2-9.4), and 8.6 (95%CI 8.4-8.7) years, respectively. The age of menarche in thin, normal, overweight, and obese groups were 13.1 (95%CI 12.4-13.7), 11.6 (95%CI 11.4-11.7), and 11.1 (95%CI 11.0-11.2) years, respectively. The interval ages between B2 and B5 and between P2 and P5 was 4.5 and 4.1 years, respectively in the overweight and obese groups, and those in normal group and thin group was 4.7 and 4.5 years, 4.6 and 4.7 years, respectively. Conclusions: The ages of sexual characteristics development and menarche tend in Tongzhou District of Beijing to be earlier than that being reported of Beijing's survey 20 years ago. Girls characterized as overweight and obese not only start puberty at an earlier age than girls of normal weight, but also have a shorter developmental process.

Children's odor pleasantness ratings may not differ according to pubertal status: Preliminary results from a sample of 11–14-year-old Czech children

Puberty tends to be viewed as a “turning point” in hedonic perception of body odor (BO)-related smells. The pubertal stage, a potential proxy for the underlying physiological changes, may contribute to variation in odor hedonic perception. Other potential modulators of odor hedonics are general semantic knowledge about odors (which also tends to be subsumed under the term “age”) and perceived odor intensity. The present cross-sectional study examined differences in hedonic odor perception across puberty in 205 Czech children aged 11–14 (89 boys). We investigated whether children differ in the hedonic appraisal of BO-related (16-androstenes and castoreum control), but also food and non-food odors according to their pubertal (penis/breast and pubic hair) development and general semantic knowledge about odors (operationalized as odor identification), controlling for age and perceived odor intensity. As a subsidiary aim, we examined variation in odor identification. We asked the children to self-stage themselves using drawings depicting Tanner's penis/breast and pubic hair stages of pubertal development, estimated their general semantic knowledge about odors with a Sniffin’ Sticks identification test, and obtained their pleasantness and intensity ratings of body odor-related, food, a non-food smells. We found that the participants’ ratings of the 16-androstenes and those of the perceptually similar odor of castoreum differed according to perceived intensity and, in the latter case, in boys vs. girls as well, but there were no influences of pubertal status or odor identification on the perceived pleasantness. Similarly, hedonic appraisal of non-food (but not food) odors was only influenced by perceived intensity. Regarding odor identification, differences between boys and girls were limited to younger children and did not become more marked throughout puberty. Perceived pleasantness of odors, irrespective of whether they are associated with body smells, food, or other, does not appear to vary across puberty, and boys and girls seem to achieve similar levels of semantic odor knowledge as they grow up.

Time-varying associations of gestational and childhood triclosan with pubertal and adrenarchal outcomes in early adolescence.

Triclosan is an endocrine-disrupting chemical, but associations with pubertal outcomes remain unclear. We examined associations of gestational and childhood triclosan with adolescent hormone concentrations and pubertal stage. We quantified urinary triclosan concentrations twice during pregnancy and seven times between birth and 12 years in participants recruited from Cincinnati, OH (2003-2006). We averaged concentrations across pregnancy and childhood and separately considered individual exposure periods in multiple informant models. At 12 years, we measured serum hormone concentrations (males [n = 72] and females [n = 84]-dehydroepiandrosterone-sulfate, luteinizing hormone, follicle-stimulating hormone; males-testosterone; females-estradiol). Also at age 12 years, participants self-reported physical development and menarchal timing. We estimated associations (95% confidence interval) of triclosan with hormone concentrations, more advanced physical development, and age at menarche. For females, each doubling of childhood triclosan was associated with 16% lower estradiol concentrations (-29%, 0%), with stronger associations for measures closer to adolescence. We found suggestive evidence that higher triclosan at any age was associated with ~10% (for gestational triclosan: -18%, -2%) lower follicle-stimulating hormone concentrations among males and early postnatal (1-3 years) triclosan was associated with 63% (5%, 96%) lower odds of advanced pubic hair development in females. In multiple informant models, each doubling of gestational triclosan concentrations was associated with 5% (0%, 9%) earlier age at menarche, equivalent to 5.5 months. Gestational and childhood triclosan concentrations were related to some pubertal outcomes including hormone concentrations and age at menarche. Our findings highlight the relevance of elucidating potential sex-specific and time-dependent actions of triclosan.

Heterosexual precocious puberty due to virilizing adrenocortical adenoma

ABSTRACT This case details a 5-year-old girl with a 3-month history of heterosexual precocious puberty, presenting with clitoral enlargement and pubic hair development. In our patient, the clinical and hormonal characteristics were suggestive of adrenocortical carcinoma. However, radiological and histopathological findings indicated adrenocortical adenoma. This case highlights the diagnostic complexities that exist in pediatric adrenocortical tumors.

Characteristics of Puberty in a Population-Based Sample of Danish Adolescents

PurposeTo describe the duration, timing, tempo, and synchronicity of puberty, as well as the correlation between timing and tempo of puberty. MethodsOverall, 15,819 of 22,439 invited children participated in the Puberty Cohort within the Danish National Birth Cohort. Participants completed a web-based questionnaire every 6 months through maturation with questions on current pubertal status. Girls reported current Tanner stage of breast and pubic hair development, and timing of menarche. Boys reported current Tanner stage of genital and pubic hair development, timing of first ejaculation, and vocal changes. While accounting for this interval-censored puberty information, we estimated the duration of puberty. Then, we used a nonlinear mixed effect growth model to estimate timing, tempo, synchronicity of puberty, and correlation between timing and tempo of puberty. ResultsIn girls, the average duration of breast development was longer, whereas the average tempo was slower than pubic hair development. The average timing of breast development was earlier than the average timing of pubic hair development. The majority of girls had asynchronous puberty. In boys, the average duration was longer and average tempo slower for genital than pubic hair development. The average timing of genital and pubic hair development were comparable; hence, the majority had synchronous pubertal development. Adolescents who had earlier timing also tended to have a faster tempo. DiscussionBeing one of the largest puberty cohorts worldwide, these unique contemporary data can help physicians, parents, and children to understand and anticipate expected progression through pubertal development.

Mediation effects of lean mass and fat mass on the relationship between body mass index and handgrip strength.

This study aimed to assess the mediation effects of lean mass and fat mass on the relationship between body mass index (BMI) and handgrip strength (HGS) in adolescents. The sample included 118 adolescents (60 girls) aged 10-14 years. Body composition, determined from lean mass (LM) and fat mass (FM), was measured by dual-energy x-ray absorptiometry. HGS was measured using a digital dynamometer. Moderate-to-vigorous physical activity and sexual maturation, treated as covariates, were evaluated by accelerometry and pubic hair development, respectively. Spearman correlation and simple mediation analysis were used for statistical analysis. A positive relationship was observed between BMI and HGS (rho = .364, p < .001), BMI and LM (rho = .466, p < .001), LM and HGS (rho = .784, p < .001), BMI and FM (rho = .907, p < .001), and FM and HGS (rho = .291, p = .001). LM was the only significant mediator of the relationship between BMI and HGS. Only LM mediated the association between BMI and HGS, almost entirely explaining the relationship. The findings reinforce the need to include LM measurements in routine strength testing. Furthermore, strategies focused on LM development may be promising in preventing low muscle strength in adolescents.

Characterization of Puberty in an Australian Population-Based Cohort Study

PurposeCurrent knowledge of the characteristics of puberty beyond age at menarche and thelarche is limited, particularly within population-based cohorts. Secular trends and concerns of the health effects of early puberty reinforce the value of contemporary studies characterizing the timing, tempo, duration, and synchronicity of puberty. MethodsThe Childhood to Adolescence Transition Study is a unique Australian cohort of individuals followed annually from late childhood to late adolescence, with up to eight assessments of pubertal stage from 9 to 19 years of age (N = 1,183; 636 females). At each assessment, females reported their Tanner Stage of breast and pubic hair development, while males reported on genital/pubic hair development. Nonlinear mixed-effects models characterized pubertal trajectories and were used to derive each individual’s estimates of timing, tempo, and synchronicity. Parametric survival models were used to estimate the overall duration of puberty. ResultsTiming of mid-puberty (Tanner Stage 3) ranged from 12.5 to 13.5 years, with females developing approximately 6 months before males. Pubertal tempo (at mid-puberty) was similar across sex (between half and one Tanner Stage per year), but the overall duration of puberty was slightly shorter in males. Most females exhibited asynchronous changes of breast and pubic hair development. DiscussionEstimates of pubertal timing and tempo are consistent with reports of cohorts from two or more decades ago, suggesting stabilization of certain pubertal characteristics in predominantly White populations. However, our understanding of the duration of puberty and individual differences in pubertal characteristics (e.g., synchronicity of physical changes) remains limited.

THU182 Widening The Spectrum Of ABCC8-related Disease: Insulin-mediated Pseudoacromegaly

Abstract Disclosure: I.F. Machado: None. B.B. Mendonca: None. A. Latronico: None. M.Y. Nishi: None. L.G. Gomes: None. Introduction: Insulin-mediated pseudoacromegaly is a rare condition characterized by acromegaloid phenotype without excessive GH secretion in the context of severe hyperinsulinemia. Case report: A 10.5 years old girl with tall stature, obesity, acanthosis nigricans, neurosensorial hearing deficiency and acromegaloid features was referred for clinical investigation. She was born of non-consanguineous parents, full-term, with normal birth weight and stature. She had no history of neonatal hypoglycemia or in infancy. At six years of age, she presented marked accelerated growth velocity and weight gain resulting in bilateral slipped femoral epiphysis. She developed thelarche at 7 years old, and was treated with gonadotropin releasing hormone agonist (GnRHa) from 8-10.5 years. Hearing deficiency was diagnosed at 7 years of age. Her family history was remarkable for paternal sudden cardiac death at age 35. At physical examination, she had an acromegaloid facial appearance with a prominent forehead and jaw, large hands and feet, and severe acanthosis nigricans in neck and axillae. Her weight and height were 99.5 kgs (Z 8.8) and 170 cm (Z 4.6), respectively; target height was 1.66 m (Z 0,72) and BMI was 34.4 (Z 3.5). Her breast and pubic hair development were Tanner stage IV. Laboratory exams showed normal IGF-1 and random GH levels. There was an abnormal response of GH (2.63 ng/mL) following an oral glucose tolerance test (OGTT), considered as false positive in the context of obesity and puberty. Her brain magnetic resonance was normal. She had a hemoglobin glycated of 6.1% and very high basal insulin levels of 98 µUI/mL with a normal glucose value of 81 mg/dL and OGTT-120 minutes insulin levels &amp;gt; 1000 µUI/mL with glucose of 113 mg/dL. Exome sequencing analysis showed a heterozygous missense ABCC8 variant c.622G&amp;gt;A p.(Glu208Lys), located in an exonic hotspot, and allele frequency absent from gnomAD databases. The ACMG classified this variant as pathogenic. Pseudoacromegaly, a heterogeneous condition, is caused by multiple genetic and pathophysiological backgrounds. In insulin-mediated pseudoacromegaly, the defects are mainly associated with postreceptor insulin signaling and action. We described a new type of hyperinsulinemic pseudoacromegaly caused by a mutation in the ABCC8 gene, which encodes the sulfonylurea receptor, a member of the K(ATP) channel superfamily. This gene is associated with congenital hyperinsulinemia causing hypoglycemia, generally when in homozygous state. This clinical report illustrates a new phenotype associated with ABCC8 mutation, and identifies a new genetic cause of hyperinsulinemic pseudoacromegaly. Conclusion: We described a patient with insulin-mediated pseudoacromegaly associated with neurosensorial hearing deficiency caused by a dominant variant in the ABCC8 gene, defining a new genetic cause of this intriguing disorder. Presentation: Thursday, June 15, 2023

SAT398 Pubertal Status And Trends In Gender Affirming Treatment Of Transgender And Gender Diverse Youth

Abstract Disclosure: C. Lin: None. M. Oransky: None. R. Fader: None. N.R. Malhotra: None. E.M. Baldiserroto: None. C.J. Romero: None. J.D. Safer: None. M. Yau: None. Background: Transgender and gender diverse (TGD) youth seek care to affirm their gender identities and improve quality of life and mental health. Gender affirming care of youth includes pubertal assessment, pubertal suppression with gonadotropin-releasing hormone agonist (GnRHa) and gender-affirming hormone therapy (GAHT). Management choices are made collaboratively among the patient, the patient’s family, and the multidisciplinary treatment team. Objective: We sought to characterize the pubertal status of the TGD youth to consider medical intervention. Method: The medical records of 58 TGD youth referred to pediatric endocrinology from 2020-2022 were retrospectively analyzed. Pubertal assessments were made by visualization of pubic hair and breast development according to the Tanner scale and determination of testicular volume with an orchidometer. We labeled Tanner stage 1 as prepuberty; stages 2-3 as early puberty; and stages 4-5 as late puberty. Results: The median age was 15 years (range 8-18 years). 46.6% were trans girls (n=27), 44.8% were trans boys (n=26), and 8.6% were non-binary (n=1 natal male and n=4 natal female). Of the trans girls, 7.4% were prepubertal (n=2), 51.9% were in early puberty (n =14), and 40.7% were in late puberty (n=11). Of the trans boys, none were prepubertal, 3.6% were in early puberty (n=1), and 96.4% were in late puberty (n=25). Of the non-binary youth, 20% were in early puberty (n=1) and 80% were in late puberty (n=4).For the prepubertal patients, monitoring for onset of puberty without treatment was recommended. Of the 15 patients in early puberty, 73.3% started GnRHa (10 trans girls, 1 trans boy) and 26.7% started GAHT (4 trans girls). Of the 36 patients in late puberty, 2.8% received no treatment (1 trans boy), 25.0% started GnRHa (7 trans girls, 2 trans boys) and 72.2% started GAHT (4 trans girl, 22 trans boy). Of the 5 non-binary patients, 1 patient in early puberty (1 natal female) was treated with GnRHa, and 4 were in late puberty and initiated on GAHT (1 natal male, 3 natal female). Conclusion: In our multidisciplinary practice, trans feminine patients are evenly divided between those who present in early and late puberty. This presents possible implications for fertility preservation strategies. Trans masculine patients overwhelmingly present in late puberty, perhaps owing in part to earlier timing for typical “female” puberty. This means that even prompt initiation of GnRHa therapy cannot entirely prevent the potential future need for chest masculinization surgery. Presentation: Saturday, June 17, 2023

Early-Onset Virilization May Rarely be Due to an Adrenocortical Neoplasm

Background: Adrenocortical tumors are rare neoplasms of childhood; most of which are functional in childhood, producing excess hormones. Virilization, precocious puberty, and Cushing's syndrome are common presenting features. Clinical Description: A 6-year-8-month-old girl presented with features of virilization, which started appearing at 2 ½ years of age. The mother gave a history of progressive enlargement of the clitoris with the development of pubic, axillary, and facial hair over the years. There was no history of perinatal complications, features of adrenal insufficiency, atypical external genitalia at birth, or family history of malignancy. On examination, she had features of heterosexual peripheral precocious puberty. The hormonal investigation was suggestive of cortisol and androgen excess. Radiologically, she had an adrenal tumor appearing like adrenocortical carcinoma (ACC)-large size, high noncontrast Hounsfield units, and poor washout. Management and Outcome: As virilization was not present since birth and there was no evidence of adrenal insufficiency, therefore, the possibility of congenital adrenal hyperplasia was unlikely. Investigations revealed that the testosterone levels were much higher than other adrenal androgen precursors like dehydroepiandrosterone sulfate. This was a clinical clue to the well-differentiated and benign nature of the tumor although radiologically it appeared like ACC. The child underwent en bloc resection of the mass, and histopathology was suggestive of a benign adrenocortical adenoma. Seven days after surgery, the serum testosterone had dropped substantially. Conclusion: This case creates awareness about the possibility of an adrenocortical neoplasm in a child with early-onset virilization, which can be diagnosed correctly by following a step-wise, logical sequence of investigations.

Combined pituitary hormone deficiency harboring CHD7 gene missense mutation without CHARGE syndrome: a case report

BackgroundHeterozygous loss-of-function mutations in the chromodomain helicase DNA-binding protein 7 (CHD7) gene cause CHARGE syndrome characterized by various congenital anomalies. A majority of patients with CHARGE syndrome present with congenital hypogonadotropic hypogonadism (HH), and combined pituitary hormone deficiency (CPHD) can also be present. Whereas CHD7 mutations have been identified in some patients with isolated HH without a diagnosis of CHARGE syndrome, it remains unclear whether CHD7 mutations can be identified in patients with CPHD who do not fulfill the criteria for CHARGE syndrome.Case presentationA 33-year-old woman was admitted to our hospital. She had primary amenorrhea and was at Tanner stage 2 for both pubic hair and breast development. She was diagnosed with CPHD (HH, growth hormone deficiency, and central hypothyroidism), and a heterozygous rare missense mutation (c.6745G > A, p.Asp2249Asn) in the CHD7 gene was identified. Our conservation analysis and numerous in silico analyses suggested that this mutation had pathogenic potential. She had mild intellectual disability, a minor feature of CHARGE syndrome, but did not fulfill the criteria for CHARGE syndrome.ConclusionsWe report a rare case of CPHD harboring CHD7 mutation without CHARGE syndrome. This case provides valuable insights into phenotypes caused by CHD7 mutations. CHD7 mutations can have a continuous phenotypic spectrum depending on the severity of hypopituitarism and CHARGE features. Therefore, we would like to propose a novel concept of CHD7-associated syndrome.