An LH level of more than 0.3 mIU per mL (0.3 IU per L) is the most reliable laboratory finding for central precocious puberty; however, in patients with lower values and high clinical suspicion, a gonadotropin-releasing hormone analogue stimulation test may be warranted.6,34 In cases of diagnostic uncertainty, pelvic ultrasonography can evaluate for increased uterine and ovarian volume expected for age, which may indicate central precocious puberty or a tumor.6, The appropriate timing for neuroimaging to identify central nervous system lesions (e.g., hypothalamic hamartoma, malignancy) in children with precocious puberty is controversial. Timing of maturation and predictors of menarche in girls enrolled in a contemporary British cohort. Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Still, she added, many girls who develop early are not overweight. Thats a very marked change in a very short period of time, Dr. Juul said. eCollection 2022. The lowest factor score was for moderation in the obese group, at 42.5 3.6. That did not seem right, said Dr. Herman-Giddens, who is now an adjunct professor at the University of North Carolina Gillings School of Global Public Health. Kim J., Kim S., Huh K., Kim Y., Joung H., Park M. High serum isoflavone concentrations are associated with the risk of precocious puberty in Korean girls. Identification and Optimization of Contributing Factors for Precocious Puberty by Machine/Deep Learning Methods in Chinese Girls. The data are presented as number (%) or the mean standard deviation. OR, odds ratio; CI, confidence interval. Nutrition during prepuberty, and even during infancy and childhood, has a significant impact on pubertal development, and several studies have reported that pubertal development is more rapid in obese children [5,6,7]. Obesity has been linked to earlier periods in girls since the 1970s. All rights reserved. Accessibility Endocr Dev. Precocious puberty is thought to be the result of a complex interaction between genetic, environmental and physical factors. You might have seen that some reusable food container brands have labels that say "BPA-free." Clinical expression of precocious puberty in girls. Body weight was measured using an electronic scale and recorded in kilograms. Those five factors are then further divided into questions on datary intake and behavior: balance (5 questions: intake frequency of whole grains, fruits, white milk, eggs, and legumes); diversity (3 questions: intake frequency of colorful vegetables, kimchi, and diverse side dishes); moderation (5 questions: intake frequency of fast foods, sweet foods, instant noodles, eating at night, and street foods), regularity (3 questions: meal regularity, eating breakfast, and exercise); practice (3 questions: hand washing, chewing well, and checking nutrition labels) [18]. Chan School of Public Health and a co-author of the analysis. It is categorized as central or peripheral precocious puberty depending on the primary cause; central (also known as true) precocious puberty is a result of premature activation of the hypothalamicpituitarygonadal axis. Through this, it was possible to suggest a direction for improving the health of children with precocious puberty and to emphasize the importance of the parental role. History and physical examination should be followed by measurements of serum follicle-stimulating hormone, luteinizing hormone, and testosterone (boys) or estradiol (girls); and bone age radiography. Pediatric endocrinology. Chen C., Chen Y., Zhang Y., Sun W., Jiang Y., Song Y., Zhu Q., Mei H., Wang X., Liu S., et al. Anthropometric status and biochemical data according to obesity status. Res. Zitelli BJ, et al. In boys, on the other hand, precocious puberty is less common but, when it occurs, potentially dangerous structural central nervous system abnormalities are more common than in girls [2]. Additionally, hormone production may be influenced by obesity due to overeating, stress, and environmental factors [ 4, 5, 6 ]. This study was conducted by multistage and stratified cluster random sampling. http://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/precocious-puberty. Multivariate logistic regressions of an association between various factors and obesity status. Central Precocious Puberty. Precocious puberty. After menarche, girls grow an average of 7 cm.14,1418, Precocious puberty is diagnosed when secondary sexual characteristics are identified in girls younger than eight years and boys younger than nine years.5,6 Data suggest a trend toward early pubertal development. The ePub format is best viewed in the iBooks reader. [Epidemiologic study on current pubertal development in Chinese school-aged children]. 25.98% and 38.58% of boys with precocious puberty were respectively accompanied by obesity (OR=2.15, 95% CI=1.31 to 3.50) or central obesity (OR=2.10, 95% CI=1.46 to 3.03); meanwhile, 13.86% and 29.42% of girls with precocious puberty were respectively accompanied by obesity (OR=9.00, 95% CI=5.60 to 14.46) or central obesity (OR=5.40, 95% CI=4.10 to 7.12). Overweight was defined as children with a BMI in the 8594th percentile for age and sex, and obese was classified as those in the 95th percentile and above. Rarely, certain conditions, such as infections, hormone disorders, tumors, brain abnormalities or injuries, may cause precocious puberty. Pediatrics. Perceived self-esteem among children diagnosed with precocious puberty. Zhu M, Fu J, Liang L, Gong C, Xiong F, Liu G, Luo F, Chen S. Zhejiang Da Xue Xue Bao Yi Xue Ban. You may switch to Article in classic view. ; formal analysis, Y.J.W. Anthropometric data, including age, height, and weight, were acquired from medical records at the time of diagnosis. Family influences on childrens physical activity and fruit and vegetable consumption. 1999 Oct;104(4 Pt 1):936-41. doi: 10.1542/peds.104.4.936. In 1999, he argued that the age cutoff for normal puberty should be lowered to age 7 in white girls and 6 in Black girls. Anecdotally, the same thing might be happening in India, Turkey and the United States. The cause of precocious puberty often can't be found. Exploring parenting variables associated with sweetness preferences and sweets intake of children. [25]. Central precocious puberty (CPP) is caused by abnormality in the hypothalamus-pituitary-gonadal axis. Researchers note that the earlier age of puberty seems to go along with the rise of obesity in the U.S. Lee K.A. 2017 Aug 23;7(8):e014004corr1. BMI, body mass index; AST, aspartate aminotransferase; ALT, alanine aminotransferase. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (, precocious puberty, obesity, parent child relations, body image, eating behavior, Correlation between childrens body mass index (BMI) z-score and parents BMI. Causal arrows are difficult to draw, however. However,. The fathers BMI showed a significant correlation with the childs BMI (r = 0.199, p = 0.006). What causes precocious puberty? Epub 2021 Feb 2. Effects of obesity on growth and puberty. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. eCollection 2022. Psychiatric risk associated with early puberty in adolescent girls. Furthermore, . The methods of the studies varied widely; some were done in boys, others in girls, and they tested for many different chemicals at different ages of exposure. Conversely, the less affection from the parent, the more the childs behavior is likely to become negative [28]. The authors declare no conflict of interest. Keywords: Analysis of the Relationship between Nutritional Status and Bone Age and Sexual Development in Children and Adolescents. Girls without breast development by 13 years of age should be evaluated for delayed puberty, and girls without menarche by 15 years of age should be evaluated for primary amenorrhea. Obesity: Excess weight and obesity is linked to early onset of menstruation in girls and early puberty in boys. Data Sources: A PubMed search was completed using the MeSH function with the key term puberty and at least one of the following qualifiers: early, precocious, delayed, absent, or disorder. Partsch C.J., Sippell W.G. doi: 10.1136/bmjopen-2016-014004corr1. In central precocious puberty, the puberty process starts too soon. . -, Golub MS, Collman GW, Foster PM, et al. Rarely, puberty occurs early because the glands that make sex hormones, the ovaries in girls and the testes in boys, start working on their own, earlier than normal. 1, normal group; 2, overweight group; 3, obesity group. A rare disorder called gonadotropin-independent familial sexual precocity, which is caused by a defect in a gene, can result in the early production of testosterone in boys, usually between ages 1 and 4. Other risk factors for precocious puberty include: obesity; . It may comprise of central or gonadotropin-dependent. Health Conditions. In this study, the results regarding body shape awareness and satisfaction showed that childrens dissatisfaction with overweight or obesity was lower than the results reported by Cho et al. EPIDEMIOLOGY; Obesity; PAEDIATRICS; Puberty. Pediatrics. 17 620 Chinese children aged 6-12 years. Lim J.H., Kim J.H. The brain starts the process with the production of a hormone called gonadotropin-releasing hormone (GnRH). how many bullets for quarterly award sloan el-100-a manual pharmacy technician diploma 1 year masters programs abroad diamond sharpening stone ace hardware . Stress and trauma could prompt earlier development, or, as Dr. Herman-Giddens hypothesized decades ago, girls who physically develop earlier could be more vulnerable to abuse. Compared to boys with healthy weights, boys with obesity had a 2.7 times higher risk of early-onset puberty. For delayed puberty, a history suggestive of underlying chronic disease (e.g., fatigue, pain, abnormal stools), nutrition and exercise patterns, poor psychosocial functioning, cryptorchidism, anosmia [i.e., in Kallmann syndrome]) is important. In children with precocious puberty, the better the parental communication and intimacy with the child, the lower the anxiety. 2022 Jun 3;10:795596. doi: 10.3389/fped.2022.795596. At the time, Dr. Juul suggested that the earlier onset of puberty in the United States was probably tied to a rise in childhood obesity, which had not occurred in Denmark. The mean BMI of the mothers was 22.8 2.8 kg/m2 and was the highest among mothers of those in the overweight group (p < 0.001). Sampling theme of the study. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. In the decade after the Herman-Giddens study, Dr. Juul began noticing an increase in the number of referrals for early puberty in Copenhagen, mostly of girls who were developing breasts at 7 or 8 years old. 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). Results: Referral to a pediatric endocrinologist may be warranted after the initial evaluation. -. If puberty begins younger than those cutoffs, doctors are supposed to screen the child for a rare hormonal disorder called central precocious puberty, which can spur puberty as early as infancy. A notable result was that parents negative perceptions or dissatisfaction were greater than that of their children. Association between dietary patterns and precocious puberty in children: a population-based study. All subjects voluntarily agreed to participate in the study after receiving a detailed description of the procedures and goals. ; writingoriginal draft preparation, Y.J.W. In a 2009 study of nearly 1,000 school-aged girls in Copenhagen, his team found that the average age of breast development had dropped by a year since his earlier study, to a little under 10, with most girls ranging from 7 to 12 years old. Dr. Juul has become one of the most vocal proponents of an alternate theory: that chemical exposures are to blame. With shared decision making, parents can weigh the risks of sedation, intravenous contrast media, and follow-up imaging (leading to anxiety and high cost) against the low likelihood that imaging will show a new central nervous system malignancy (at most 1%).5,6,35, If started early in the course of central precocious puberty, gonadotropin-releasing hormone analogues (e.g., leuprolide [Lupron]) appear to safely prevent premature fusion of growth plates, thereby preserving height potential.36 Because of high annual costs, treatment may be most appropriate if bone age suggests impending short stature or if the patient exhibits aggression (boys) or profound emotionality in response to menses (girls).10,37, Delayed puberty is the absence of breast development by 13 years of age in girls or the absence of testicular growth to at least 4 mL in volume or 2.5 cm in length by 14 years of age in boys.79,25,38 Constitutional delay of growth and puberty is the most common cause of delayed puberty in boys (60%) and girls (30%).39,40 It represents an extreme of the normal spectrum of pubertal timing and is a diagnosis of exclusion.39,40 For more than 75% of patients with constitutional delay of growth and puberty, family history may reveal parental pubertal delay.41,42, Other etiologies of delayed puberty are categorized based on gonadotropin levels. . But the evidence that they are driving earlier puberty is murky. The Different Effects of Skeletal Muscle and Fat Mass on Height Increment in Children and Adolescents Aged 6-11 Years: A Cohort Study From China. Risk factors for precocious puberty include: Gender - it is more common in girls; Therefore, various interventions, such as environmental management, psychological support, and nutrition education, are needed that focus on the obesity and health conditions of children with precocious puberty. and transmitted securely. The functionality is limited to basic scrolling. and Y.H.H. This form of precocious puberty is called central precocious puberty, or CPP. In central precocious puberty, the brain releases GnRH at a younger-than-normal age and starts the process. Kang M.H., Lee J.S., Kim H.Y., Kwon S., Choi Y.S., Chung H.R., Kwak T.K., Cho Y.H. Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. This content does not have an Arabic version. In 2008, it was almost 20%. Elsevier Point of Care. But, unlike doctors in the United States, he did not think obesity was to blame: The body mass index of the Danish children in the 2009 cohort was no different than it had been in the 1990s. Evid Based Complement Alternat Med. Chen C., Zhang Y., Sun W., Chen Y., Jiang Y., Song Y., Lin Q., Zhu L., Zhu Q., Wang X., et al. eCollection 2017. Objectives: . The data are presented as the mean standard deviation or numbers (%). In girls, dull pink vaginal mucosa suggests estrogen exposure; virilization (e.g., clitoromegaly) should be excluded.47,9,27, The thyroid, abdomen, and neurologic system should be examined for evidence of thyroid or gastrointestinal disease or intracranial pathology. Declining age of puberty of school girls in southern Thailand. This study had several limitations. World J Pediatr 2014;10:25661.10.1007/s12519-014-0472-2 Onset of breast and pubic hair development and menses in urban Chinese girls. The number of girls was significantly higher in all three groups (p = 0.028); the ratio of males to females was higher in the overweight and obesity groups than in the normal group, but the difference was not statistically significant. This is the most common type of precocious puberty. 2022 Jun 30;13:892005. doi: 10.3389/fendo.2022.892005. Earlier pubertal development was positively associated with obesity and central obesity in Chinese children. It may be caused by tumors or growths on the ovaries, adrenal glands, pituitary gland, or brain. Other factors may also be involved in earlier puberty, at least in girls. Abnormal pubertal timing can adversely affect a child's physical and psychosocial well-being and may be caused by a range of generally benign or pathologic etiologies. Current or previous therapies, including chemotherapy, radiation therapy, or exogenous sex steroids, may indicate the underlying etiology. In: Nelson Textbook of Pediatrics. Often, the cause of precocious puberty is unknown. All Rights Reserved. Gender - precocious puberty occurs more often in girls Race - it occurs more often in African-Americans than other races Obesity Exposure to sex hormones - such as estrogen or testosterone creams or ointments, or other substances that contain these hormones Other medical conditions Symptoms & Types Common symptoms include: Breast development Update on Precocious Puberty in Girls. A study published in Italy in February showed that 328 girls were referred to five clinics across the country during a seven month period in 2020, compared with 140 during the same period in 2019. Woo T., Lee K.H. Treatment depends on the cause. In girls, precocious puberty may be caused by the early maturity of the hypothalamus, pituitary glands and ovaries. When puberty begins before age 8 in girls and before age 9 in boys, it is considered precocious puberty. The subjects of this study were patients who visited the Department of Pediatrics, Soonchunhyang University, Bucheon Hospital, and Soonchunhyang University, Gumi Hospital, for treatment of central precocious puberty from 1 January 2018 to 30 July 2019. This study aimed to evaluate environmental and dietary factors that affect obesity in children with precocious puberty and to identify key points in health management. This study was approved by the Institutional Review Board of Soonchunhyang University, Bucheon Hospital (IRB number 2017-07-004). Check the full list of possible causes and conditions now! A total of 193 children (93.3% girls) diagnosed with precocious puberty were classified into three groups according to their obesity levels. government site. Elevated estradiol levels in the setting of low LH may suggest an estrogen-secreting tumor.6 Hypothyroidism and exogenous steroid use should be excluded. Methods: Our retrospective, case-control study recruited 846 children diagnosed as having CPP and randomly . The results show that obese children with precocious puberty were more vulnerable to negative lifestyle, family environment, and self-esteem effects than their normal-weight peers. Or, he wondered, had parents and doctors become hysterical because of the news coverage of Dr. Herman-Giddenss study? Precocious puberty is rare and has a clear female predominance. By Erin Coakley on February 22, 2022. Delayed puberty can cause significant psychological distress and low self-esteem.46,47 Girls older than 13 years and boys older than 14 years with possible constitutional delay of growth and puberty or gonadotropin-releasing hormone deficiency may be offered jump-start therapy to induce puberty.5,7,8,25,45 For example, treating boys with testosterone cypionate or enanthate (e.g., 50 to 100 mg intramuscularly per month) and girls with overnight transdermal estradiol (e.g., 6.2 mcg, one-fourth of the 25-mcg 24-hour patch) for three to six months may accelerate attainment of final adult height and generally does not lead to premature epiphysis closure.7,25 If pubertal progression does not occur within four to six months after completing therapy, further evaluation for persistent hypogonadotropic hypogonadism and long-term hormone therapy should be initiated.5,7 Indications for referral to a pediatric endocrinologist are listed in eTable D. This article updates a previous article on this topic by Blondell, et al.48. Pinyerd B., Zipf W.B. The definition of precocious puberty and the role of obesity in the age of onset have also been areas of debate since the Lawson Wilkins Society recommended a lowering of the age of onset of precocious puberty in US girls. Persistent hypogonadotropic hypogonadism is caused by a congenital abnormality in the HPG axis or an acquired etiology such as a central nervous system tumor, trauma, surgery, or radiation.7,43 Patients with persistent hypogonadotropic hypogonadism require treatment to induce puberty, maintain normal adult levels of sex steroids, and optimize fertility.44 eTable C includes the differential diagnosis of delayed or absent puberty. Researchers are also investigating other potential influences, including chemicals found in certain plastics and stress. Precocious puberty is defined as the onset of secondary sexual characteristics before the age of 8 years in females and 9 years in males [1]. Abnormal growth velocity necessitates assessment of serum thyroid function, prolactin, and insulinlike growth factor I. Prevalence of precocious puberty among Chinese children: a school population-based study.
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