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Puberte Prekoks ve Pediatri Hemşiresinin Rolü

Year 2020, Volume 51, Issue 1, 53 - 58, 15.01.2020
https://doi.org/10.16948/zktipb.423576

Abstract

ÖZET

Puberte Prekoks (PP) ergenliğin fiziksel ve hormonel belirtilerinin, normal kabul edilen sınırlardan daha erken ortaya çıkmasıdır. Bu yazıda, pediatri hemşirelerinin PP ile ilgili farkındalıklarının artırılması amaçlanmıştır. Bu literatür derlemesinde, PP’nin patofizyolojisi, etiyolojisi, epidemiyolojisi, kliniği, tanısı, tedavisi, hemşirelik girişimleri ve ayırıcı yanları tanımlanmıştır. Ergenliğin erken başlaması kızlarda memelerin erken büyümesine, erken menarşa, erkeklerde penis ve testislerin büyümesine, erken sperm üretimine ve libido artışına, epifiz kapaklarının erken kapanması sonucu yetişkin yaşta boy kısalıklarına sebep olabilmektedir. Fiziksel, hormonal ve psikolojik gelişimin uyumsuzluğu nedeniyle duygusal stres ve davranışsal problemler, psikososyal sorunlara sebep olmaktadır. Pediatri hemşirelerinin, PP’li çocukların erken tanılanmasında, uygun merkezlere yönlendirilmesinde, okul-aile işbirliğinin sağlanmasında ve hemşirelik yaklaşımlarının uygulanmasında önemli sorumlulukları vardır.

References

  • Kliegman RM, Stanton BF, Geme JW St, Schor NF. Disorder of pubertal development. In: Behrman RE, editors. Nelson textbook of pediatrics. 20th ed. C.V.Mosby. 2016. pp 2656-2660. ISBN 978-0-323-35307-6
  • Lifshitz F. Pediatric endocrinology: growth, adrenal, sexual, thyroid, calcium, and fluid balance disorders. İnforma Healthcare. 5th ed. CRC Press. 2006. ISBN 9781420042702 - CAT# H4270
  • Kaplowitz PB. Precocious puberty. In: Hillard PJA, editors. Practical pediatric and adolescent gynecology. 2013. pp 87-90. doi: 10.1002/9781118538555.ch15
  • Park J, Kim JH. Change in body mass index and insulin resistance after 1-year treatment with gonadotropin-releasing hormone agonists in girls with central precocious puberty. Annals of Pediatric Endocrinology & Metabolism. 2017; 22(1): 27-35.
  • Brito VN, Latronico AC, Arnhold IJ, Mendonça BB. Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arquivos Brasileiros de Endocrinologia & Metabologia. 2008; 52(1):18-31.
  • Berberoglu M. Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. Journal of Clinical Research in Pediatric Endocrinology. 2009; 1(4):164–74.
  • Kim EY, Lee MI. Psychosocial aspects in girls with idiopathic precocious puberty. Psychiatry İnvestigation. 2012; 9(1): 25-8.
  • Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009; 123(4), 752-62.
  • McKinney ES, James SR, Murray SS, Nelson K, Ashwill J. Precocious puberty. Maternal-child nursing. 5th ed. Canada: Elsevier Health Sciences; 2017. pp 1256-1257. ISBN9780323478342
  • Ricci SS, Kyle T. Precocious puberty. Maternity and pediatric nursing. China: Wolters Kluwer Healty; 2009. pp 1599-1600. ISBN 0781780551, 9780781780551
  • CDC-Centers for Disease Control and Prevention . National health and nutrition examination survey III, 1988-1994. 2018 Mar; Available from http://www.icpsr.umich.edu/icpsrweb/NACDA/studies/2231.
  • Herman-Giddens ME, Slora EJ, Wasserman RC, Bourdony CJ, Bhapkar MV, Koch GG, Hasemeier CM. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the pediatric research in office settings network. Pediatrics. 1997; 99(4): 505-12.
  • Karlberg J. Secular trends in pubertal development. Hormone Research in Paediatrics. 2002; 57(Suppl 2): 19-30.
  • Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon, JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocrine Reviews. 2003; 24(5), 668-93.
  • Aycan Z. Delayed puberty. Turkish Archives of Pediatrics. 2011; 46(11): 88-91.
  • Hockenberry MJ, Wilson D. Precocious puberty. Clinical companion for Wong's essentials of pediatric nursing. 8th ed. USA: Elsevier Health Sciences; 2008. pp 299-301. ISBN 978-0323053549
  • Hockenberry MJ, Wilson D. Precocious puberty. Wong's nursing care of infants and children. 10th ed. Canada: Elsevier Health Sciences; 2014. pp 1501-1502. ISBN 0323293395
  • Partsch CJ, Heger S, Sippell, WG. Management and outcome of central precocious puberty. Clinical Endocrinology. 2002; 56(2): 129-48.
  • Faizah M Z, Zuhanis AH, Rahmah R, Raja AA, Wu LL, Dayang AA, Zulfiqar MA. Precocious puberty in children: a review of imaging findings. Biomedical İmaging and İntervention Journal. 2012; 8(1): e6.
  • Chan YM, Fenoglio-Simeone KA, Paraschos S, Muhammad L, Troester MM, Ng Yu-tze, Johnsonbaugh RE, Coons SW, Prenger EC, Kerrigan Jr JF, Seminara SB. Central precocious puberty due to hypothalamic hamartomas correlates with anatomic features but not with expression of GnRH, TGFα, or KISS1. Hormone Research in Paediatrics. 2010; 73(5): 312-9.
  • James SR, Nelson KA, Ashwill JW. The child with an endocrine or metabolic alteration. Nursing care of children: Principles and practice. 4th ed. Saunders; 2013. pp 700-730. ISBN 9781455703661
  • Euling SY, Selevan SG, Pescovitz OH, Skakkebaek N. Role of environmental factors in the timing of puberty. Pediatrics. 2008; 121(Suppl.3): 167-71.
  • Nebesio TD, Eugster EA. Current concepts in normal and abnormal puberty. Current Problems in Pediatr Adolescent Health Care. 2007; 37(2): 50-72.
  • Synovitz LB, Chopak-Foss J. Precocious puberty: Pathology, related risks, and support strategies. Open Journal of Preventive Medicine. 2013; 3(9): 504-9.
  • Carel JC, Leger J. Precocious puberty. The New England Journal of Medicine. 2008; 358(22): 2366-77.
  • Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Archives of Disease in Childhood. 1969; 44(235): 291-303.
  • Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Archives of Disease in Childhood. 1970; 45(239): 13-23.
  • Carel JC, Lahlou N, Jaramillo O, Montauban V, Teinturier C, Colle M, Lucas C, Chaussain JL. Treatment of central precocious puberty by subcutaneous injections of leuprorelin 3-month depot (11.25 mg). The Journal of Clinical Endocrinology & Metabolism. 2002 Sep; 87(9): 4111-6.
  • Lee PA. Laboratory monitoring of children with precocious puberty. Archives of Pediatrics and Adolescent Medicine, 1994; 148(4), 369-76.
  • Sloboda DM, Hart R, Doherty DA, Pennell CE, Hickey M. Age at menarche: influences of prenatal and postnatal growth. The Journal of Clinical Endocrinology and Metabolism. 2007; 92(1): 46-50.
  • de Vries L, Horev G, Schwartz M, Phillip M. Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. European Journal of Endocrinology. 2006; 154(6), 891-8.
  • Battaglia C, Mancini F, Regnani G, Persico N, Iughetti L, De Aloysio D. Pelvic ultrasound and color doppler findings in different isosexual precocities. Ultrasound Obstet Gynecol, 2003; 22(3): 277-83.
  • Chalumeau M, Chemaitilly W, Trivin C, Adan L, Bréart G, Brauner R. Central precocious puberty in girls: an evidence-based diagnosis tree to predict central nervous system abnormalities. Pediatrics. 2002; 109(1): 61-7.
  • Chemaitilly W, Trivin C, Adan L, Gall V, Sainte-Rose C, Brauner R. Central precocious puberty: clinical and laboratory features. Clinical Endocrinology. 2001; 54(3): 289–94.
  • Ojeda SR, Lomniczi A, Mastronardi C, Heger S, Roth C, Parent AS, Matagne V, Mungenast AE. The neuroendocrine regulation of puberty: is the time ripe for a systems biology approach? Endocrinolgy. 2006; 147(3): 1166-74.
  • Kaplowitz PB. Treatment of central precocious puberty. Current Opinion in Endocrinology, Diabetes and Obesity. 2009; 16(1): 31-6.
  • Tuvemo T, Gustafsson J, Proos LA. Swedish Growth Hormone Group. Suppression of puberty in girls with short-acting intranasal versus subcutaneous depot GnRH agonist. Hormone Research in Paediatrics. 2002; 57(1-2): 27-31.
  • Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL. Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. Journal of Pediatrics. 1995; 127(1): 47–52.
  • Antoniazzi F, Arrigo T, Cisternino M, Galluzzi F, Bertelloni S, Pasquino AM, Borrelli P, Osio D, Mengarda F, De Luca F, Tatò L. End results in central precocious puberty with GnRH analog treatment: the data of the Italian study group for physiopathology of puberty. Journal of Pediatric Endocrinology and Metabolism. 2000; 13(Suppl.): 773-80.
  • Paterson WF, McNeill E, Young D, Donaldson MD. Auxological outcome and time to menarche following long-acting goserelin therapy in girls with central precocious or early puberty. Clinical Endocrinology. 2004; 61(5): 626-34.
  • Arrigo T, De Luca F, Antoniazzi F, Galluzzi F, Iughetti L, Pasquino AM, Salerno MC, Marseglia L, Crisafulli G. Menstrual cycle pattern during the first gynaecological years in girls with precocious puberty following gonadotropin-releasing hormone analogue treatment. European Journal of Pediatrics. 2007; 166(1): 73-4.
  • Bertelloni S, Mul D. Treatment of central precocious puberty by GnRH analogs: long-term outcome in men. Asian Journal of Andrology. 2008; 10(4): 525-34.
  • Schoelwer M, Eugster EA. Treatment of peripheral precocious puberty. Endocrine Development. 2016; 29: 230–9.
  • Datta P. Endocrine disorders in children. Pediatric nursing. 3th ed. India: Jaypee Brothers Medical Publishers; 2014. pp 424-425. ISBN 978-9351521488
  • Blondell RD, Foster MB, Dave KC. Disorders of puberty. American Family Physician. 1999; 60(1): 209-18.
  • Rastogi MV, Boston BA. Precocious puberty. The Global Library Of Women’s Medicine. 2008; doi: 10.3843/GLOWM.10292.

Precocious Puberty and Role of Pediatric Nurse

Year 2020, Volume 51, Issue 1, 53 - 58, 15.01.2020
https://doi.org/10.16948/zktipb.423576

Abstract

 

ABSTRACT

Precocious puberty (PP) is the physical and hormonal manifestations of early pubertal development occurring at an earlier age than the normally accepted limit. With this present article it is aimed to increase the awareness of pediatric nurses about PP. In this literatüre review, the definition of PP pathophysiology, etiology, epidemiology, clinic, diagnosis, treatment, nursing initiatives and definitive diagnosis. The early onset of puberty can lead to early growth of the mammals, premature menstruation, growth in the penis and testes in boys, early onset of sperm production and increased libido, due to early closure of the epiphyses in children and short stature in the adult years. Emotional stress or behavioral problems cause psychosocial problems due to incompatibility of physical, hormonal and psychological development. Pediatric nurses have important responsibilities in the early diagnosis of PP children, in the orientation to appropriate centers, in the implementation of school-family cooperation as well as of the application of nursing approaches to the necessary precautions. 

References

  • Kliegman RM, Stanton BF, Geme JW St, Schor NF. Disorder of pubertal development. In: Behrman RE, editors. Nelson textbook of pediatrics. 20th ed. C.V.Mosby. 2016. pp 2656-2660. ISBN 978-0-323-35307-6
  • Lifshitz F. Pediatric endocrinology: growth, adrenal, sexual, thyroid, calcium, and fluid balance disorders. İnforma Healthcare. 5th ed. CRC Press. 2006. ISBN 9781420042702 - CAT# H4270
  • Kaplowitz PB. Precocious puberty. In: Hillard PJA, editors. Practical pediatric and adolescent gynecology. 2013. pp 87-90. doi: 10.1002/9781118538555.ch15
  • Park J, Kim JH. Change in body mass index and insulin resistance after 1-year treatment with gonadotropin-releasing hormone agonists in girls with central precocious puberty. Annals of Pediatric Endocrinology & Metabolism. 2017; 22(1): 27-35.
  • Brito VN, Latronico AC, Arnhold IJ, Mendonça BB. Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arquivos Brasileiros de Endocrinologia & Metabologia. 2008; 52(1):18-31.
  • Berberoglu M. Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. Journal of Clinical Research in Pediatric Endocrinology. 2009; 1(4):164–74.
  • Kim EY, Lee MI. Psychosocial aspects in girls with idiopathic precocious puberty. Psychiatry İnvestigation. 2012; 9(1): 25-8.
  • Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009; 123(4), 752-62.
  • McKinney ES, James SR, Murray SS, Nelson K, Ashwill J. Precocious puberty. Maternal-child nursing. 5th ed. Canada: Elsevier Health Sciences; 2017. pp 1256-1257. ISBN9780323478342
  • Ricci SS, Kyle T. Precocious puberty. Maternity and pediatric nursing. China: Wolters Kluwer Healty; 2009. pp 1599-1600. ISBN 0781780551, 9780781780551
  • CDC-Centers for Disease Control and Prevention . National health and nutrition examination survey III, 1988-1994. 2018 Mar; Available from http://www.icpsr.umich.edu/icpsrweb/NACDA/studies/2231.
  • Herman-Giddens ME, Slora EJ, Wasserman RC, Bourdony CJ, Bhapkar MV, Koch GG, Hasemeier CM. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the pediatric research in office settings network. Pediatrics. 1997; 99(4): 505-12.
  • Karlberg J. Secular trends in pubertal development. Hormone Research in Paediatrics. 2002; 57(Suppl 2): 19-30.
  • Parent AS, Teilmann G, Juul A, Skakkebaek NE, Toppari J, Bourguignon, JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocrine Reviews. 2003; 24(5), 668-93.
  • Aycan Z. Delayed puberty. Turkish Archives of Pediatrics. 2011; 46(11): 88-91.
  • Hockenberry MJ, Wilson D. Precocious puberty. Clinical companion for Wong's essentials of pediatric nursing. 8th ed. USA: Elsevier Health Sciences; 2008. pp 299-301. ISBN 978-0323053549
  • Hockenberry MJ, Wilson D. Precocious puberty. Wong's nursing care of infants and children. 10th ed. Canada: Elsevier Health Sciences; 2014. pp 1501-1502. ISBN 0323293395
  • Partsch CJ, Heger S, Sippell, WG. Management and outcome of central precocious puberty. Clinical Endocrinology. 2002; 56(2): 129-48.
  • Faizah M Z, Zuhanis AH, Rahmah R, Raja AA, Wu LL, Dayang AA, Zulfiqar MA. Precocious puberty in children: a review of imaging findings. Biomedical İmaging and İntervention Journal. 2012; 8(1): e6.
  • Chan YM, Fenoglio-Simeone KA, Paraschos S, Muhammad L, Troester MM, Ng Yu-tze, Johnsonbaugh RE, Coons SW, Prenger EC, Kerrigan Jr JF, Seminara SB. Central precocious puberty due to hypothalamic hamartomas correlates with anatomic features but not with expression of GnRH, TGFα, or KISS1. Hormone Research in Paediatrics. 2010; 73(5): 312-9.
  • James SR, Nelson KA, Ashwill JW. The child with an endocrine or metabolic alteration. Nursing care of children: Principles and practice. 4th ed. Saunders; 2013. pp 700-730. ISBN 9781455703661
  • Euling SY, Selevan SG, Pescovitz OH, Skakkebaek N. Role of environmental factors in the timing of puberty. Pediatrics. 2008; 121(Suppl.3): 167-71.
  • Nebesio TD, Eugster EA. Current concepts in normal and abnormal puberty. Current Problems in Pediatr Adolescent Health Care. 2007; 37(2): 50-72.
  • Synovitz LB, Chopak-Foss J. Precocious puberty: Pathology, related risks, and support strategies. Open Journal of Preventive Medicine. 2013; 3(9): 504-9.
  • Carel JC, Leger J. Precocious puberty. The New England Journal of Medicine. 2008; 358(22): 2366-77.
  • Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Archives of Disease in Childhood. 1969; 44(235): 291-303.
  • Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Archives of Disease in Childhood. 1970; 45(239): 13-23.
  • Carel JC, Lahlou N, Jaramillo O, Montauban V, Teinturier C, Colle M, Lucas C, Chaussain JL. Treatment of central precocious puberty by subcutaneous injections of leuprorelin 3-month depot (11.25 mg). The Journal of Clinical Endocrinology & Metabolism. 2002 Sep; 87(9): 4111-6.
  • Lee PA. Laboratory monitoring of children with precocious puberty. Archives of Pediatrics and Adolescent Medicine, 1994; 148(4), 369-76.
  • Sloboda DM, Hart R, Doherty DA, Pennell CE, Hickey M. Age at menarche: influences of prenatal and postnatal growth. The Journal of Clinical Endocrinology and Metabolism. 2007; 92(1): 46-50.
  • de Vries L, Horev G, Schwartz M, Phillip M. Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. European Journal of Endocrinology. 2006; 154(6), 891-8.
  • Battaglia C, Mancini F, Regnani G, Persico N, Iughetti L, De Aloysio D. Pelvic ultrasound and color doppler findings in different isosexual precocities. Ultrasound Obstet Gynecol, 2003; 22(3): 277-83.
  • Chalumeau M, Chemaitilly W, Trivin C, Adan L, Bréart G, Brauner R. Central precocious puberty in girls: an evidence-based diagnosis tree to predict central nervous system abnormalities. Pediatrics. 2002; 109(1): 61-7.
  • Chemaitilly W, Trivin C, Adan L, Gall V, Sainte-Rose C, Brauner R. Central precocious puberty: clinical and laboratory features. Clinical Endocrinology. 2001; 54(3): 289–94.
  • Ojeda SR, Lomniczi A, Mastronardi C, Heger S, Roth C, Parent AS, Matagne V, Mungenast AE. The neuroendocrine regulation of puberty: is the time ripe for a systems biology approach? Endocrinolgy. 2006; 147(3): 1166-74.
  • Kaplowitz PB. Treatment of central precocious puberty. Current Opinion in Endocrinology, Diabetes and Obesity. 2009; 16(1): 31-6.
  • Tuvemo T, Gustafsson J, Proos LA. Swedish Growth Hormone Group. Suppression of puberty in girls with short-acting intranasal versus subcutaneous depot GnRH agonist. Hormone Research in Paediatrics. 2002; 57(1-2): 27-31.
  • Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL. Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. Journal of Pediatrics. 1995; 127(1): 47–52.
  • Antoniazzi F, Arrigo T, Cisternino M, Galluzzi F, Bertelloni S, Pasquino AM, Borrelli P, Osio D, Mengarda F, De Luca F, Tatò L. End results in central precocious puberty with GnRH analog treatment: the data of the Italian study group for physiopathology of puberty. Journal of Pediatric Endocrinology and Metabolism. 2000; 13(Suppl.): 773-80.
  • Paterson WF, McNeill E, Young D, Donaldson MD. Auxological outcome and time to menarche following long-acting goserelin therapy in girls with central precocious or early puberty. Clinical Endocrinology. 2004; 61(5): 626-34.
  • Arrigo T, De Luca F, Antoniazzi F, Galluzzi F, Iughetti L, Pasquino AM, Salerno MC, Marseglia L, Crisafulli G. Menstrual cycle pattern during the first gynaecological years in girls with precocious puberty following gonadotropin-releasing hormone analogue treatment. European Journal of Pediatrics. 2007; 166(1): 73-4.
  • Bertelloni S, Mul D. Treatment of central precocious puberty by GnRH analogs: long-term outcome in men. Asian Journal of Andrology. 2008; 10(4): 525-34.
  • Schoelwer M, Eugster EA. Treatment of peripheral precocious puberty. Endocrine Development. 2016; 29: 230–9.
  • Datta P. Endocrine disorders in children. Pediatric nursing. 3th ed. India: Jaypee Brothers Medical Publishers; 2014. pp 424-425. ISBN 978-9351521488
  • Blondell RD, Foster MB, Dave KC. Disorders of puberty. American Family Physician. 1999; 60(1): 209-18.
  • Rastogi MV, Boston BA. Precocious puberty. The Global Library Of Women’s Medicine. 2008; doi: 10.3843/GLOWM.10292.

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Review
Authors

Selen ÖZAKAR AKÇA> (Primary Author)
HİTİT ÜNİVERSİTESİ, SAĞLIK YÜKSEKOKULU
0000-0002-6943-6713
Türkiye


Ahu Pınar TURAN>
HİTİT ÜNİVERSİTESİ, SAĞLIK YÜKSEKOKULU
0000-0002-7645-8320
Türkiye


Havva Nur PELTEK KENDİRCİ>
HİTİT ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0001-7398-765X
Türkiye

Publication Date January 15, 2020
Published in Issue Year 2020, Volume 51, Issue 1

Cite

Bibtex @review { zktipb423576, journal = {Zeynep Kamil Tıp Bülteni}, issn = {1300-7971}, eissn = {2148-4864}, address = {}, publisher = {Zeynep Kamil Kadın ve Çocuk Hastalıkları EAH}, year = {2020}, volume = {51}, number = {1}, pages = {53 - 58}, doi = {10.16948/zktipb.423576}, title = {Precocious Puberty and Role of Pediatric Nurse}, key = {cite}, author = {Özakar Akça, Selen and Turan, Ahu Pınar and Peltek Kendirci, Havva Nur} }
APA Özakar Akça, S. , Turan, A. P. & Peltek Kendirci, H. N. (2020). Precocious Puberty and Role of Pediatric Nurse . Zeynep Kamil Tıp Bülteni , 51 (1) , 53-58 . DOI: 10.16948/zktipb.423576
MLA Özakar Akça, S. , Turan, A. P. , Peltek Kendirci, H. N. "Precocious Puberty and Role of Pediatric Nurse" . Zeynep Kamil Tıp Bülteni 51 (2020 ): 53-58 <https://dergipark.org.tr/en/pub/zktipb/issue/52318/423576>
Chicago Özakar Akça, S. , Turan, A. P. , Peltek Kendirci, H. N. "Precocious Puberty and Role of Pediatric Nurse". Zeynep Kamil Tıp Bülteni 51 (2020 ): 53-58
RIS TY - JOUR T1 - Precocious Puberty and Role of Pediatric Nurse AU - Selen Özakar Akça , Ahu Pınar Turan , Havva Nur Peltek Kendirci Y1 - 2020 PY - 2020 N1 - doi: 10.16948/zktipb.423576 DO - 10.16948/zktipb.423576 T2 - Zeynep Kamil Tıp Bülteni JF - Journal JO - JOR SP - 53 EP - 58 VL - 51 IS - 1 SN - 1300-7971-2148-4864 M3 - doi: 10.16948/zktipb.423576 UR - https://doi.org/10.16948/zktipb.423576 Y2 - 2018 ER -
EndNote %0 Medical Bulletin of Zeynep Kamil Precocious Puberty and Role of Pediatric Nurse %A Selen Özakar Akça , Ahu Pınar Turan , Havva Nur Peltek Kendirci %T Precocious Puberty and Role of Pediatric Nurse %D 2020 %J Zeynep Kamil Tıp Bülteni %P 1300-7971-2148-4864 %V 51 %N 1 %R doi: 10.16948/zktipb.423576 %U 10.16948/zktipb.423576
ISNAD Özakar Akça, Selen , Turan, Ahu Pınar , Peltek Kendirci, Havva Nur . "Precocious Puberty and Role of Pediatric Nurse". Zeynep Kamil Tıp Bülteni 51 / 1 (January 2020): 53-58 . https://doi.org/10.16948/zktipb.423576
AMA Özakar Akça S. , Turan A. P. , Peltek Kendirci H. N. Precocious Puberty and Role of Pediatric Nurse. Zeynep Kamil Tıp Bülteni. 2020; 51(1): 53-58.
Vancouver Özakar Akça S. , Turan A. P. , Peltek Kendirci H. N. Precocious Puberty and Role of Pediatric Nurse. Zeynep Kamil Tıp Bülteni. 2020; 51(1): 53-58.
IEEE S. Özakar Akça , A. P. Turan and H. N. Peltek Kendirci , "Precocious Puberty and Role of Pediatric Nurse", Zeynep Kamil Tıp Bülteni, vol. 51, no. 1, pp. 53-58, Jan. 2020, doi:10.16948/zktipb.423576