BibTex RIS Kaynak Göster

Prematüre Pubarş Olgularının Değerlendirilmesi: Tek Merkez Deneyimi

Yıl 2017, Cilt: 11 Sayı: 1, 34 - 39, 01.04.2017

Öz

Amaç: Çalışmada prematüre pubarşlı (PP) olguların başlangıçtaki ve izlem süresindeki antropometrik, klinik ve laboratuvar verilerinin değerlendirilmesi amaçlandı.Gereç ve Yöntemler: Kızlarda 8, erkeklerde 9 yaşından önce pubik ve/veya aksiller kıllanma yakınmasıyla başvuran toplam 117 olgu (110 kız) (ortalama takip süreleri 16.2±13.5 ay) geriye dönük olarak değerlendirildi.Bulgular: Kızların ortalama yaşı 7.2±0.9 yıl (ort±standart sapma), semptomların görülmesi 6.4±1.3 yaş ve ortalama kemik yaşı 8.0±1.3 yıl, kemik yaşı/kronolojik yaş oranı 1.1, boy standart deviasyon skoru 0.6±1.2, hedef boy 159.1±5.3 cm ve tahmini erişkin boy 157.7±7.5 cm’di. Erkeklerde, kronolojik yaş 8.4±0.8 yıl, semptomların başlama yaşı 7.7±1.1’di. Kızların %53.7’si ve erkeklerin %56’sı fazla kiloluydu. Tüm hastaların %21’i düşük doğum ağırlıklıydı (DDA) ve %14’ü prematüre doğmuştu. Serum dehidroepiandrosteron sülfat seviyesi hastaların %76.5’inde 40 μg/dl üzerindeydi ve kemik yaşı ile pozitif ilişkiliydi. Başlangıçta iki hasta klasik konjenital adrenal hiperplazi (21 hidroksilaz eksikliği) ve 9 hasta konjenital adrenal hiperplazi taşıyıcısı tanısı aldı. İzlemde telarşa eşlik eden 12 kıza (%11) luteinizan hormon salgılatıcı hormon testi ile santral puberte prekoks tanısı konuldu. Klinik başlangıcı prematüre pubarş olan 117 olgunun son tanıları şu şekildeydi: 94 (%80) prematüre pubarş, 12 (%11) santral erken puberte, 9 (%7.3) konjenital adrenal hiperplazi taşıyıcısı ve 2 (%2.7) klasik konjenital adrenal hiperplazi.Sonuç: Prematüre pubarşlı olguların %20’sine başka bir klinik patoloji tanımlandığından, ayırıcı tanının sadece başlangıçta değil, takipte de dikkatle gözden geçirilmesi gerektiği vurgulanmak istendi. Ayrıca, ılımlı ilerlemiş kemik yaşının hedef boyu olumsuz etkilemeyeceği sonucuna varıldı.

Kaynakça

  • Atay Z, Turan S, Guran T, Furman A, Bereket A. The prevelance and risk factors of premature thelarche and pubarche in 4 to 8 year old girls. Acta Paediatr 2012;101:71-5.
  • Ghizzoni L, Gasco V. Premature pubarche. Horm Res Paediatr 2010;73:420 2.
  • de Ferran K, Paiva IA, Garcia Ldos S, Gama Mde P, Guimarães MM. Isolated premature pubarche: Report of anthropometric and metabolic profile of a Brazilian cohort of girls. Horm Res Paediatr 2011;75:367-73.
  • Ibáñez L, Díaz R, López-Bermejo A, Marcos MV. Clinical spectrum of premature pubarche: Links to metabolic syndrome and ovarian hyperandrogenism. Rev Endocr Metab Disord 2009;10:63-76.
  • Rosenfield RL. Clinical review: Identifying children at risk for polycystic ovary syndrome. J Clin Endocrinol Metab 2007;92:787- 96.
  • Charkaluk ML,  Trivin C,  Brauner R. Premature pubarche as an indicator of how body weight influences the onset of adrenarche. Eur J Pediatr 2004;163:89-93.
  • Utriainen P, Jääskeläinen J, Romppanen J, Voutilainen R. Childhood metabolic syndrome and its components in premature adrenarche. J Clin Endocrinol Metab 2007;92:4282-5.
  • Morales AJ,  Holden JP,  Murphy AA. Pediatric and adolescent gynecologic endocrinology. Curr Opin Obstet Gynecol  1992;4: 860-6.
  • Rosenfield RL. Evidence that idiopathic functional adrenal hyperandrogenism is caused by dysregulation of adrenal steroidogenesis and that hyperinsulinemia may be involved. J Clin Endocrinol Metab 1996;81:878-80.
  • Teixeira RJ,  Silva VC,  Gazolla HM,  Cunha SB,  Guimarães MM. The relationship between ovarian structure and serum insulin, insulin-like growth factor-I (IGF-I) and its binding protein (IGFBP-1 and IGFBP-3) levels in premature pubarche. J Pediatr Endocrinol Metab 2002;15:69-75.
  • Wen SW, Smith G, Yang Q, Walker M. Epidemiology of preterm birth and neonatal outcome. Semin Fetal Neonatal Med 2004;9:429-35.
  • Bundak R,  Furman A,  Gunoz H,  Darendeliler F,  Bas F,  Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006;95:194-8.
  • Neyzi O,  Furman A,  Bundak R,  Gunoz H,  Darendeliler F,  Bas F. Growth references for Turkish children aged 6 to 18 years. Acta Paediatr 2006;95:1635-41.
  • Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, ve ark. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı ve Hastalıkları Dergisi 2008;51:1-14.
  • WHO. int [Internet]. Health topics: Body mass index-BMI. Available from: http://www.euro.who.int/en/health-topics/disease- prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi.
  • Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291-303.
  • Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2nd ed. Stanford: Stanford University Press, 1959.
  • Meas T, Chevenne D, Thibaud E, Léger J, Cabrol S, Czernichow P,  Lévy-Marchal C. Endocrine consequences of premature pubarche in post-pubertal Caucasian girls. Clin Endocrinol (Oxf) 2002;57:101-6.
  • March of Dimes, PMNCH, Save the Children, WHO. Born Too Soon: The Global Action Report on Preterm Birth. Howson CP, Kinney MV, Lawn JE (eds). Geneva: World Health Organization, 2012.
  • Papathanasiou A, Lekka G,  Evangelopoulou C,  Petrou V, Petros P, Nikolopoulos P, et al.  Effect of body weight on bone age and hormonal parameters in children with premature adrenarche. Pediatrics 2008;121:105-6.
  • Remer T,  Manz F. Role of nutritional status in the regulation of adrenarche. J Clin Endocrinol Metab 1999;84:3936-44.
  • Jabbar M,  Pugliese M,  Fort P,  Recker B,  Lifshitz F. Excess weight and precocious pubarche in children: Alterations of the adrenocortical hormones. J Am Coll Nutr 1991;10:289-96.
  • Hatun S. The frequency and state of childhood obesity in Turkey and in the world. J Clin Res Pediatr Endocrinol 2012;1:7-14.
  • Ibáñez L,  Dimartino-Nardi J,  Potau N,  Saenger P. Premature adrenarche-normal variant or forerunner of adult disease? Endocr Rev 2000;21:671-96.
  • Auchus RJ, Rainey WE. Adrenarche - physiology, biochemistry and human disease. Clin Endocrinol (Oxf) 2004;60:288-96.
  • L’Allemand D. Adrenal androgens: Examination of their normal and pathological regulation during childhood. Fakultatstrat Medizinischen kajultat Cahrite der Humbolt-Universtat zu Berlin, 2003. http://edoc.hu-berlin.de/habilitationen/l-allemand-jander- dagmar-2003-07-17/HTML/front.html#:contents
  • Oron T,  Lebenthal Y,  de Vries L,  Yackobovitch-Gavan M,  Phillip M, Lazar L. Interrelationship of extent of precocious adrenarche in appropriate for gestational age girls with clinical outcome. J Pediatr 2012;160:308-13.
  • Saenger P, Reiter EO. Premature adrenarche: A normal variant of puberty. J Clin Endocrinol Metab 1992;74:236-8.

Evaluation of Premature Pubarche Cases: A Single Center Experience

Yıl 2017, Cilt: 11 Sayı: 1, 34 - 39, 01.04.2017

Öz

Objective: We aimed to evaluate anthropometric, clinical and laboratory findings of cases with premature pubarche (PP) at baseline and during follow-up.Material and Methods: A total of 117 cases (110 girls), who presented with the complaint of pubic and/or axillary hair growth before 8 years of age for girls and 9 years for boys, were evaluated retrospectively (the mean fallow up period was 16.2±13.5 months).results: The mean age of the girls was 7.2±0.9 years, the mean age at symptom initiation was 6.4±1.3 years and the mean bone age (BA) was 8.0±1.3 years. The ratio of BA/chronological age (CA) was 1.1, height standard deviation score (SDS) was 0.6±1.2, target height was 159.1±5.3 cm and predicted height was 157.7±7.5 cm. The mean CA of boys was 8.4±0.8 years and the mean age at the initiation of symptoms among the patients was 7.7±1.1 years. 53.7% of girls and 56% of boys were overweight. 21% of all patients had low birth weight (LBW) and 14% were premature at birth. Serum dehydroepiandrosterone sulfate level was higher than 40 µg/dL in 76.5% of patients revealing positive correlation with BA. Two patients were diagnosed with classical congenital adrenal hyperplasia (CAH) (21 hydroxylase deficiency) and nine were found to be CAH carriers at the beginning. On follow-up, 12 girls (11%) with accompanying thelarche were diagnosed with central puberte precox (CPP) after the luteinizing hormone releasing hormone test. The final diagnosis of 117 cases that clinically had PP on the beginning was as follows: 94 (80%) PP, 12(11%) CPP, 9 (7.3%) CAH carrier and 2 (2.7%) classical CAH.conclusion: As another clinic pathology was determined in 20% of PP cases during the repeated evaluations, we would like to emphasize that the differential diagnosis should be performed very attentively not only at the beginning, but also on follow-up. It was found that mildly advanced bone age would not affect the final height unfavorably

Kaynakça

  • Atay Z, Turan S, Guran T, Furman A, Bereket A. The prevelance and risk factors of premature thelarche and pubarche in 4 to 8 year old girls. Acta Paediatr 2012;101:71-5.
  • Ghizzoni L, Gasco V. Premature pubarche. Horm Res Paediatr 2010;73:420 2.
  • de Ferran K, Paiva IA, Garcia Ldos S, Gama Mde P, Guimarães MM. Isolated premature pubarche: Report of anthropometric and metabolic profile of a Brazilian cohort of girls. Horm Res Paediatr 2011;75:367-73.
  • Ibáñez L, Díaz R, López-Bermejo A, Marcos MV. Clinical spectrum of premature pubarche: Links to metabolic syndrome and ovarian hyperandrogenism. Rev Endocr Metab Disord 2009;10:63-76.
  • Rosenfield RL. Clinical review: Identifying children at risk for polycystic ovary syndrome. J Clin Endocrinol Metab 2007;92:787- 96.
  • Charkaluk ML,  Trivin C,  Brauner R. Premature pubarche as an indicator of how body weight influences the onset of adrenarche. Eur J Pediatr 2004;163:89-93.
  • Utriainen P, Jääskeläinen J, Romppanen J, Voutilainen R. Childhood metabolic syndrome and its components in premature adrenarche. J Clin Endocrinol Metab 2007;92:4282-5.
  • Morales AJ,  Holden JP,  Murphy AA. Pediatric and adolescent gynecologic endocrinology. Curr Opin Obstet Gynecol  1992;4: 860-6.
  • Rosenfield RL. Evidence that idiopathic functional adrenal hyperandrogenism is caused by dysregulation of adrenal steroidogenesis and that hyperinsulinemia may be involved. J Clin Endocrinol Metab 1996;81:878-80.
  • Teixeira RJ,  Silva VC,  Gazolla HM,  Cunha SB,  Guimarães MM. The relationship between ovarian structure and serum insulin, insulin-like growth factor-I (IGF-I) and its binding protein (IGFBP-1 and IGFBP-3) levels in premature pubarche. J Pediatr Endocrinol Metab 2002;15:69-75.
  • Wen SW, Smith G, Yang Q, Walker M. Epidemiology of preterm birth and neonatal outcome. Semin Fetal Neonatal Med 2004;9:429-35.
  • Bundak R,  Furman A,  Gunoz H,  Darendeliler F,  Bas F,  Neyzi O. Body mass index references for Turkish children. Acta Paediatr 2006;95:194-8.
  • Neyzi O,  Furman A,  Bundak R,  Gunoz H,  Darendeliler F,  Bas F. Growth references for Turkish children aged 6 to 18 years. Acta Paediatr 2006;95:1635-41.
  • Neyzi O, Günöz H, Furman A, Bundak R, Gökçay G, Darendeliler F, ve ark. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans değerleri. Çocuk Sağlığı ve Hastalıkları Dergisi 2008;51:1-14.
  • WHO. int [Internet]. Health topics: Body mass index-BMI. Available from: http://www.euro.who.int/en/health-topics/disease- prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi.
  • Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291-303.
  • Greulich WW, Pyle SI. Radiographic atlas of skeletal development of the hand and wrist. 2nd ed. Stanford: Stanford University Press, 1959.
  • Meas T, Chevenne D, Thibaud E, Léger J, Cabrol S, Czernichow P,  Lévy-Marchal C. Endocrine consequences of premature pubarche in post-pubertal Caucasian girls. Clin Endocrinol (Oxf) 2002;57:101-6.
  • March of Dimes, PMNCH, Save the Children, WHO. Born Too Soon: The Global Action Report on Preterm Birth. Howson CP, Kinney MV, Lawn JE (eds). Geneva: World Health Organization, 2012.
  • Papathanasiou A, Lekka G,  Evangelopoulou C,  Petrou V, Petros P, Nikolopoulos P, et al.  Effect of body weight on bone age and hormonal parameters in children with premature adrenarche. Pediatrics 2008;121:105-6.
  • Remer T,  Manz F. Role of nutritional status in the regulation of adrenarche. J Clin Endocrinol Metab 1999;84:3936-44.
  • Jabbar M,  Pugliese M,  Fort P,  Recker B,  Lifshitz F. Excess weight and precocious pubarche in children: Alterations of the adrenocortical hormones. J Am Coll Nutr 1991;10:289-96.
  • Hatun S. The frequency and state of childhood obesity in Turkey and in the world. J Clin Res Pediatr Endocrinol 2012;1:7-14.
  • Ibáñez L,  Dimartino-Nardi J,  Potau N,  Saenger P. Premature adrenarche-normal variant or forerunner of adult disease? Endocr Rev 2000;21:671-96.
  • Auchus RJ, Rainey WE. Adrenarche - physiology, biochemistry and human disease. Clin Endocrinol (Oxf) 2004;60:288-96.
  • L’Allemand D. Adrenal androgens: Examination of their normal and pathological regulation during childhood. Fakultatstrat Medizinischen kajultat Cahrite der Humbolt-Universtat zu Berlin, 2003. http://edoc.hu-berlin.de/habilitationen/l-allemand-jander- dagmar-2003-07-17/HTML/front.html#:contents
  • Oron T,  Lebenthal Y,  de Vries L,  Yackobovitch-Gavan M,  Phillip M, Lazar L. Interrelationship of extent of precocious adrenarche in appropriate for gestational age girls with clinical outcome. J Pediatr 2012;160:308-13.
  • Saenger P, Reiter EO. Premature adrenarche: A normal variant of puberty. J Clin Endocrinol Metab 1992;74:236-8.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Diğer ID JA39YB86SF
Bölüm Research Article
Yazarlar

Aytaç Göktuğ Bu kişi benim

Zehra Aycan Bu kişi benim

Aşan Önder Bu kişi benim

Elif Sağsak Bu kişi benim

Melikşah Keskin Bu kişi benim

Semra Çetinkaya Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2017
Gönderilme Tarihi 1 Nisan 2017
Yayımlandığı Sayı Yıl 2017 Cilt: 11 Sayı: 1

Kaynak Göster

Vancouver Göktuğ A, Aycan Z, Önder A, Sağsak E, Keskin M, Çetinkaya S. Evaluation of Premature Pubarche Cases: A Single Center Experience. Türkiye Çocuk Hast Derg. 2017;11(1):34-9.

13548  21005     13550