Etiological, clinical and biochemical characteristics of 367 children with early pubertal development from the Trakya region of Turkey

Year 2022, Volume: 47 Issue: 4, 1412 - 1423, 28.12.2022

Sebile Kılavuz , Diğdem Bezen , Necdet Süt , Emine Dilek , Filiz Tütüncüler

https://doi.org/10.17826/cumj.1176227

Abstract

Background: Appearance of menarche before nine years of age, secondary sex characteristics before 8 in girls and 9 in boys is defined as Precocious Puberty (PP).
Objective: The aim of this study was to describe etiologies, clinical findings, and compare anthropometric properties and biochemical characteristics of children with PP.
Methods: In this single-centre study, 367 patients of whom medical records were reviewed diagnosed as premature thelarche (PT), premature adrenarche (PA), Central PP (CPP), and peripheral PP (PPP). The diagnosis was based on clinical, laboratory, and radiologic investigations and their follow-up.
Results: During six years, 349 girls (%95,1) and 18 boys (%4,9) diagnosed as PP. The most common etiologies were CPP;127 (%34,6), PT;117 (%31,9), PA;112(%30,5) and PPP 11(%3), respectively. CPP group had significantly higher levels of height, weight, body mass index (BMI) and obesity/overweight incidence, estradiol (E2), basal luteinizing hormone (LH), peak LH, and peak LH/ follicle-stimulating hormone (FSH) ratio and higher uterine dimensions compared to the PT group while the PT group had significantly higher levels of peak FSH compared to the CPP group (p<0,05). It is impossible for the laboratory results to exactly match in each case with CPP, and the cases should be evaluated along with other clinical findings.

Conclusion: We detected an increase in the frequency of girls referred with PP signs in our study. The majority of children with PP were revealed as an incomplete type with a very low incidence of endocrine pathology. The complexity of pathogenesis in PP should lead us to be cautious about the consequences of PP in patients and evaluate their complaints, physical findings, and laboratory work-up seriously, such as a piece of a puzzle.

Keywords

Central precocious puberty, premature thelarche, premature adrenarche, Estradiol, DHEA-S, FSH, LH.

Türkiye’nin Trakya bölgesinde erken prepubertal gelişim ile takip edilen 367 çocuğun biyokimyasal klinik ve etiyolojik özellikleri

Abstract

Amaç: Menarşın dokuz yaşından önce ortaya çıkması, ikincil cinsiyet özelliklerinin kızlarda 8, erkeklerde 9 yaşından önce görülmesi Erken Puberte (EP) olarak tanımlanır. Bu çalışmanın amacı, EP'li çocukların etiyolojilerini, klinik bulgularını tanımlamak ve antropometrik özellikleri ile biyokimyasal özelliklerini karşılaştırmaktır.
Yöntem: Bu tek merkezli çalışmada tıbbi kayıtları incelenen 367 hastaya erken telarş (ET), erken adrenarş (EA), gerçek erken puberte (GEP) ve Periferik Erken Puberte (PEP) tanıları kondu. Tanı klinik, laboratuvar, radyolojik incelemeler ve bunların takibine dayanıyordu.
Bulgular: Altı yıl içinde 349 kız (%95,1) ve 18 erkek (%4,9) EP tanısı aldı. En sık etiyoloji sırasıyla GEP;127 (%34,6), ET;117 (%31,9), EA;112(%30,5) ve PEP 11(%3) idi. GEP grubunda boy, kilo, vücut kitle indeksi (BMI) ve obezite/fazla kilolu insidansı, östradiol (E2), bazal lüteinize edici hormon (LH), pik LH ve pik LH/FSH oranı anlamlı olarak daha yüksekti ve ET grubuna göre uterus boyutları daha yüksekken, ET grubu GEP grubuna göre anlamlı olarak daha yüksek pik FSH seviyelerine sahipti (p<0,05). Her olguda laboratuvar sonuçlarının GEP ile tam olarak eşleşmesi mümkün değildir ve olgular diğer klinik bulgularla birlikte değerlendirilmelidir.
Sonuç: Çalışmamızda EP bulguları ile başvuran kızların sıklığında artış saptadık. EP'li çocukların çoğu, endokrin patoloji insidansı çok düşük olan inkomplet tip olarak ortaya çıktı. EP'deki patogenez oldukça karmaşıktır ve EP tanılı hasta sonuçları konusunda dikkatli olunmalı ve şikayet, fizik muayene ve laboratuvar bulguları yapbozun bir parçası olarak ciddi bir şekilde değerlendirilmelidir.

Keywords

Central precocious puberty, premature thelarche, premature adrenarche, Estradiol, DHEA-S, FSH, LH.

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