Sağlam Çocuk Polikliniğinde Prematür Telarş Olgularında Çevresel Maruziyet Değerlendirilmesi

Öz

Sekiz yaşından küçük kız çocuklarında cinsel olgunlaşma belirtisi olmadan meme gelişimi, neredeyse evrensel olarak prematür telarş (PT) olarak kabul edilir. Prevelans ve etiyoloji açıkça bilinmemektedir. Çalışmamızda, unilateral veya bilateral PT olan kız çocuklarını izlemini yapmak ve bakım ürünlerini kullanmayı bıraktıklarındaki gerilemeyi göstermeyi amaçladık. Çalışma retrospektif planlandı. Eylül 2016 ile Şubat 2017 tarihleri arasında izlemde olan prematür telarş tanısı almış çocuklar ve ebeveynleri çalışmaya dahil edildi. Sağlam çocuk izleminde olan pubik veya aksiller kıllanma, vajinal kanama veya diğer cinsel olgunlaşma bulgusu ile ilişkisi olmayan unilateral veya bilateral meme gelişimi olan tüm çocukların tek semptomu vardı. Organik bir neden saptanmayan bu çocuklarda, bakım ürünleri kesildikten sonra izleme alındı. 28 kız çocuğu değerlendirildi ve ortalama yaş 2,3 (± 0,3) yıl idi. Çocukların kronik hastalığı yoktu. Tüm vakalar Tanner evre 2 olarak tanımlandı ve erken meme gelişimi nedeniyle takibe alındı. 18 (%64,2) kız çocuğun unilateral meme gelişimi vardı. Bakım ürünleri kullanmayı kestikten sonra, unilateral ve bilateral meme gelişimi olan çocuklarda 6 ay içinde gerileme oldu. Günümüzde, PT ve Puberte prekoks veya erken meme gelişimi riskini gösteren herhangi bir öngörücü test yoktur. Çocukların, bakım ürün kullanımı nedeniyle birçok teste maruz kalabilir. Klinisyenler bu türlü ürünler yönünden dikkatli olmalıdırlar. Aileler çocukları için bakım ürünlerinin kullanım miktarını asgari düzeyde tutabilirler.

Anahtar Kelimeler

• prematür telarş,çevre,bakım ürünleri

Envorinmental Exposure Assessment in Premature Thelarche Cases in the Well-Child Outpatient Poliklinic.

Öz

Backround: Breast development, without any signs of sexual maturation, in girls younger than 8 years is almost universally accepted as premature thelarche (PT). Prevalance and etiology are clearly unknown. Objectives: We designed a study to follow up girls who had unilateral or bilateral PT and to show regression after stopping care products. Material and Methods: The design of study was retrospective Children and their parents were enrolled into the study from September 2016 to February 2017. All children had one common symptom which was unilateral or bilateral breast development not associated with pubic or axillary hair, vaginal bleeding or other sign of sexual maturation, at the well child visit. In these children with no organic causes, monitoring was taken after stopping of care products. Result: 28 girls were evaluated and mean age was 2,3 years (± 0,3). Noone had a chronic disease. All cases identified as Tanner stage-2 and continued to have early breast development on follow-up. 18 (64,2%) girls had unilateral breast development. After stopping care products, both group had regression in six months. Conclusions: Currently there are no predictive tests to show the risk of breat development of early or puberty precoccus. Children may be exposed to much more diagnostic tests because of overuse products. Physician must be aware of these products. Families may use a minimum amount of care products for their children.

Anahtar Kelimeler

• Premature Thelarche,envorimental,care products

Kaynakça

1. Referans1 Marshall WA, Tanner JM. Variotios in pattern of pubertal changes in girls. Arch Dis Child 1969; 44: 291-303
2. Referans2 Atay Z, Turan S, Guran T, Furman A, Bereket A. The prevalence and risk factors of premature thelarche and pubarche in 4- to 8-year-old girls. Acta Pediatrica 2012:101,pp; e71-e75
3. Referans3 Pasquino AM, Piccolo F, Scalamandre A, Malvaso M, Ortolani R, Boscherini B. Hypothalamo-pituitary-gonadotropin function in girls with premature thelarche. Arch Dis Child 1980; 55: 941-944
4. Referans4 Tenore A, Franzese A, Quattrin T, Sandomenico ML, Aloi G, Gallo P et al. Prognostic signs in the evolution of premature thelarche by discriminant analysis. J Endocrinol Invest 1991; 14: 375-381
5. Referans5 Ma HM, Du ML, Luo XP, Chen SK, Liu L, ChenRM, et al. Pubertal Study Group of the Society of Pediatric Endocrinology and Genetic Disease, Chinese Medical Association. Onset of breast and pubic hair development and menses in urban chinese girls. Pediatrics 2009; 124:e269
6. Referans6 Landrigan P, Garg A, Droller DB. Assesing the effects of endocrine disruptors in the National Children’s Study. Environ Health Perpect. 2003: Oct 111 (13): 1678-1682
7. Referans7 Andersson AM, Skakkebaek NE. Exposure to exogenous estrogens in food: possible impact on human development and health. Eur J Endocrinol 1999; 140: 477
8. Referans8 Van Winter JT, Noller KL, Zimmerman D, Melton LJ 3rd. Natural history of premature thelarche in Olmsted Country, Minnesota, 1940 to 1984. J Pediatrics 1990; 116: 278-90

9. ,Referans9 Verrotti A, Ferrari M, Morgese G, Chiarelli F. Premature thelarche: a long term follow up. Gynecol Endocrinol 1996; 10: 241-7
10. Referans10 Mills JM, Stolley PD, Davies J, Moshang T Jr. Premature Thelarche-natural history and etiologic investigation. Am J Dis Child 1981;135:743-5
11. Referans11 De Vries L, Guz-Mark A, Lazar L, Reches A, Phillip M. Premature Thelarche: Age at presentation affects clinical course but nor clinical characteristics or risk to progress to precocious puberty. J Pediatr 2010; 156: 466-71
12. Referans12 Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. Standford: Standford University Pres 1959: 51-57
13. Referans13 Griffin IJ, Cole TJ, Duncan KA, Hollman AS, Donaldson MD. Pelvic ultrasound measurement in normal girls. Acta Paediatr 1995 ; 84:536-543
14. Referans14 Gokcay G, Furman A, Neyzi O. Updated growth curves for Turkish children aged 15 days to 60 months. Child Care Dev 2008; 34:454-463
15. Referans15 Golub M. Adolescent health and the environment. Environment Health Perspectives, 2000; 108, 355-362
16. Referans16 Tiwary C. Premature sexual development in children following the use of estrogen or placenta-containing hair products. Clin Pediatr 1998; 37: 733-739.
17. Referans17 Cooke PS, Simon L, Denslow ND. Endocrine Disruptors, Haschek and Rousseaux’s Handbook of Toxicologic Pathology, Third Ed. p1123-1153. (ELsevier), USA
18. Referans18 Curfman AL, Reljanovic SM, McNeils KM, Dong TT, Lewis SA, Jackson LW, CromerBA. Premature thelarche in infants and toddlers: Prevalance, natural history and environment determinants. J Pediatr Adolesc Gynecol. 2011 Dec; 24(6): 338-41.
19. Referans19 Teilman G, Juul A, Skakkebaek NE, Toppari J. Putative effects endocrine distrupters on pubertal development in the human. Best Pract Res 2002; 16: 105-121
20. Referans20 Aksglaede L, Sorensen K, Petersen JH, Skakkebaek NE, Juul A. Recent decline in age at breast development: the Copenhagen Puberty Study. Pediatrics 2009; 123: e932-9
21. Referans21 Rosenfield RL, Lipton RB, Drum ML. Thelarche, pubarche and menarche attainment in children with normal and elevated body mass index. Pediatrics 2009: 123; 84-88
22. Referans22 Ibanez L, Ferrer A, Marcos MV, Hierro FR, de Zegher F. Early puberty: rapid progression and reduced final height in girls with low birth weight. Pediatrics 2000; Nov; 106 (5): E72.
23. Referans23 Nelson KG. Premature thelarche in children born prematurely. J Pediatr 1983; 103: 756-8
24. Referans24 Pasquino AM, Pucarelli I, Passeri F, Segni M, Mancini MA, Municchi G. Progression of premature thelarche to central precocious puberty. J Prediatrics 1995; 126:11-4
25. Referans25 Volta C, Bernasconi S, Cisternino M, Buzi F, Ferzetti A, Street ME et al. Isolated premature thelarche and thelarche variant: clinical and auxiological follow up 119 girls. J Endocrinol Invest 1998;21:180-3
26. Referans26 Pasquino AM, Pucarelli I, Passeri F, Segni M, Mancini MA, Municchi G. Progression of premature thelarche: a follow up study of 40 girls. Natural history and endocrine findings. Arch Dis Child 1985: 60:1180
27. Referans27 Zhu SY, Du ML, Huang TT. An analysis of predictive factors for the conversion from premature thelarche into complete central precocious puberty. J Pediatr Endocrinol Metab 2008;21:533