Çocuk Sağlığı İzlem Birimine Başvuran Prematür Telarş Vakaları

Öz

Amaç: Son yıllarda, cinsel olgunlaşmanın erken başlamasına yol açan bazı çevresel etkenlerin varlığı düşünülmektedir. Bu nedenle, prematür telarş vakalarını değerlendirilmeyi amaçladık. Yöntemler: İstanbul Tıp Fakültesi, Çocuk Sağlığı İzlem Birimi’ne 2006-2008 yılları arasında başvuran 1163 çocuk arasında, klinik muayene ile prematür telarş belirlenen 15 vaka ayrıntılı olarak incelendi ve izlendi. Vakalar beslenme ve bazı ev içi etkenler açısından kontrol grubu ile karşılaştırıldılar. Bulgular: On beş vakada klinik prematür telarş saptandı. Prematür telarş vakalarının yaş ortalaması 8,2 ay 1-24 ay , ortalama tanı yaşı 6,2 ay bulundu. Bir vakada FSH, bir vakada E2 yüksekliği, pelvis ultrason incelemesinde üç vakada overlerde kist saptandı. Meme gelişimi ortalama 5,4 ayda aralık: 4-8 ay geriledi. Bir vaka, erken puberte tanısı aldı. Vakalar arasında normal doğum oranı yüksek bulundu. Vaka grubunda bitki çaylarının, kontrol grubunda gebelikte meyve tüketiminin daha yüksek olmasına karşın, her iki grup arasında, beslenme ve çevresel etkenler açısından anlamlı fark bulunmadı. Sonuç: Prematür telarş vakaları, erken puberte açısından yakın izlenmelidirler. Ailelerin kaygılarını giderecek yaklaşımda bulunmak, anne sütü ile beslenmeyi sonlandırmak gibi yanlış uygulamaları önlemek gerekmektedir. Vakalarımızın uzunca bir süre izlenmiş olmaları, olası etkenlerle ilgili bilgi toplanmış olması ve iki yaşından küçük çocuklar olmaları araştırmamızın üstün yanlarıdır.

Anahtar Kelimeler

• Prematür telarş,çocuk,çevre

Premature Thelarche Cases Attending Well-Child Care Surveillance Unit

Öz

Objective: Early sexual maturation has been attributed to some environmental factors in recent years. Therefore, we aimed to evaluate the cases with premature telarche. Methods: Among 1163 children attending the Child HealthCare Surveillance Unit between January 2006-December 2008, 15 cases identified clinically as premature telarche had undergone a detailed examination and follow up. The cases were compared to the control group for nutrition of both mother and child, and some domestic factors. Results: Fifteen 1,2 percent cases were diagnosed as premature telarche clinically. The mean age was 8.2 months 1-24 mos , and the mean age of diagnosis was 6.2 months. One case had increased FSH and another increased E2 levels. Cysts were identified in three cases on pelvic ultrasound examination. The mean time to the regression of the breast development was 5.4 months 4-8 months . One case was referred with the diagnosis of early puberty. Normal delivery rate was higher among the cases. Although higher consumption of herbal tea was higher among the cases and the fruit consumption was higher among the controls during pregnancy, no significant difference was found between the two groups as for nutrition and environmental factors. Conclusion: The cases with premature thelarche should be closely followed-up as for early puberty. Concerns of the families should be resolved, and false practices such as cessation of the breastfeeding should be prevented. Our study has some superiorities in that the infants and toddlers were followed-up for a relatively longer period of time, substantial information related to potential causes were collected, and our study population consisted of children younger than 2 years

Anahtar Kelimeler

• Premature thelarche,child,environment

Kaynakça

1. 1. Tanner JM. Growth at adolescence. Oxford, England Blackwell Scientific Publications. (2nd ed.), 1962: 29-39.
2. 2. Kelch RP, Beitinis IZ. Adolescent Sexual Development. In: Wilkins The diagnosis and treatment of endocrine disorders in childhood and adolescence. Kappy MS, Blizzard RM, Migeon CJ (eds), 3rd ed. Springfield: Charles C Thomas Publishner, 1965:193-235.
3. 3. Midyett LK, Moore WV, Jacobson JD. Are pubertal changes in girls before age 8 benign? Pediatrics 2003;111:47-51. http://dx.doi.org/10.1542/peds.111.1.47 PMid:12509553
4. 4. Rosenfield RL. Normal and almost normal precocious variations in pubertal development, premature pubarche and premature thelarche revisited. Horm Res 1994;41:7-13. http://dx.doi.org/10.1159/000183950 PMid:8088707
5. 5. Sizonenko PC. Preadolescent and adolescent endocrinology: physiology and physiopathology. Hormonal changes during abnormal pubertal development. Am J Dis Child 1978;132: 797-805. PMid:150791
6. 6. Klein KO, Mericq V, Brown-Dowson JM, Larmore KA, Cabezas P, Cortinez A. Estrogen levels in girls with premature thelarche compared with normal prepubertal girls as determined by an ultrasensitive recombinant cell bioassay. J Pediatr 1999;134:190-2. http://dx.doi.org/10.1016/S0022-3476(99)70414-2
7. 7. Ilicki A, Prager Lewin R, Kauli R, Kaufman H, Schachter A, Laron Z. Premature thelarche. Natural history and sex hormone secretion in 68 girls. Acta Paediatr Scand 1984;73: 756-62. http://dx.doi.org/10.1111/j.1651-2227.1984.tb17771.x
8. 8. Dumic M, Tajic M, Mardesic D, Kalafatic Z. Premature thelarche: a possible adrenal disorder. Arch Dis Child 1982; 57:200-3. http://dx.doi.org/10.1136/adc.57.3.200 PMid:6462113 PMCid:1627596

9. 9. Saenz de Rodriguez CA, Bongiovanni AM, Conde de Barrego L. An epidemic of precocious development in Puerto Rican children. J Pediatr 1985;107:393-6. http://dx.doi.org/10.1016/S0022-3476(85)80513-8
10. 10. Pasquino AM, Piccolo F, Scalamandre A, Malvaso M, Ortolani R, Boscherini B. Hypothalamic - pituitary - gonadotropic function in girls with premature thelarche. Arch Dis Child 1980;55:941-4. http://dx.doi.org/10.1136/adc.55.12.941 PMid:6779715 PMCid:1627206
11. 11. Belgorosky A, Chaler E, Rivarola MA. High serum sex hormone-binding globulin (SHBG) in premature thelarche. Clin Endocrinol 1992;37:203-6. http://dx.doi.org/10.1111/j.1365-2265.1992.tb02311.x PMid:1424201
12. 12. Garibaldi L. Progression of premature thelarche to precocious puberty. J Pediatr 1995;127:336. http://dx.doi.org/10.1016/S0022-3476(95)70337-3
13. 13. Van Winter JT, Noller KL, Zimmerman D, Melton LJ III. Natural history of premature thelarche in Olmsted County, Minnesota, 1940 to 1984. J Pediatr 1990;116:278-80. http://dx.doi.org/10.1016/S0022-3476(05)82891-4
14. 14. Pasquino AM, Tebaldi L, Cioschi L, et al. Premature thelarche: a follow up study of 40 girls. Natural history and endocrine findings. Arch Dis Childh 1985;60:1180-82. http://dx.doi.org/10.1136/adc.60.12.1180 PMid:4091585 PMCid:1777679
15. 15. Pasquino AM, Pucarelli I, Passeri F, Segni M, Mancini MA, Municchi G. Progression of premature thelarche to central precocious puberty. J Pediatr 1995;126:11-4. http://dx.doi.org/10.1016/S0022-3476(95)70492-2
16. 16. Stanhope R. Premature thelarche: clinical follow-up and indication for treatment. J Pediatr Endocrinol Metabol 2000; 13:827-30. http://dx.doi.org/10.1515/JPEM.2000.13.S1.827
17. 17. Herter LD, Golendziner E, Flores JA, Becker E Jr, Spritzer PM. Ovarian and uterine sonography in healty girls between 1 and 13 years old: correlation of findings with age and pubertal status. Am J Roentgenol 2002;178:1531-36. PMid:12034633
18. 18. Stanhope R, Adams J, Jacobs HS, Brook CG. Ovarian ultrasound assessment in normal children, idiopathic precocious puberty, and during low dose pulsatile gonadotrophin releasing hormone treatment of hypogonadotrophic hypogonadism. Arch Dis Child 1985;60:116-9. http://dx.doi.org/10.1136/adc.60.2.116 PMid:3883909 PMCid:1777151
19. 19. Cohen HL, Shapiro MA, Mandel FS, Shapiro ML. Normal ovaries in neonates and infants: a sonographic study of 77 patients 1 day to 24 months old. Am J Roentgenol 1993;160: 583-6. PMid:8430559
20. 20. Herman-Giddens ME, Slora EJ, Wasserman RC, et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings Network. Pediatrics 1999;4:505-12.
21. 21. Salardi S, Cacciari E, Mainetti B, Mazzanti L, Pirazzoli P. Outcome of premature thelarche: relation to puberty and final height. Arch Dis Child 1998;79:173-4. http://dx.doi.org/10.1136/adc.79.2.173 PMid:9797603 PMCid:1717642
22. 22. Volta C, Bernasconi S, Cisternino M, et al. Isolated premature thelarche and thelarche variant : clinical and auxological follow-up of 119 girls. J Endocrinol Investig 1998;21:180-3. PMid:9591214
23. 23. Sanfilippo JS, Muram D, Dewhurst J, Lee PA, editors. Pediatric and Adolescent Gynecology, Second Edition. New York: WB Saunders, 2001:1-702.
24. 24. Chiabotto P, Costante L, de Sanctis C. Premature thelarche and environmental pollutants. Minerva Med 2006;97:277-85. PMid:16855522