Materiały źródłowe

• #1 Pathogenesis and epidemiology of precocious puberty. Effects of exogenous oestrogens – PubMed

  https://pubmed.ncbi.nlm.nih.gov/11392376/

  Precocious puberty is generally defined as the appearance of secondary sex characteristics before age 8 years in girls (or menarche before age 9 years) and before 9 years in boys. The overall incidence of sexual precocity is estimated to be 1:5,000 to 1:10,000 children. The female-to-male ratio is approximately 10:1. […] In conclusion, the risk for children to develop precocious puberty through exposure to oestrogens (or androgens) in the environment or in food is very low. Nevertheless, studies of the effects of defined environmental oestrogenic substances on the human reproductive system and on pubertal development are warranted.

• #2 Enrichment analyses of diseases and pathways associated with precocious puberty using PrecocityDB | Scientific Reports

  https://www.nature.com/articles/s41598-021-83446-z

  Precocious puberty (PP) is an important endocrine disorder affecting children globally. […] The overall prevalence of PP is in the range of 1: 5000 to 1: 10,000 children. […] CPP is more common in girls with a female to male ratio that ranges from 3:1 to 23:1. […] The incidence of PP is higher in individuals with central nervous system (CNS) disorders or CNS lesions. […] Early onset of puberty profoundly impacts the psychosocial well-being of individuals. […] Individuals with PP suffer from short stature due to premature fusion of the growth plates. […] The cause of PP can be ascribed to genetic, metabolic, or environmental factors. […] 70-80% of the variance in pubertal timing can be attributed to genetic factors. […] Genetic studies suggest that PP has an autosomal dominant mode of inheritance.

• #3 Precocious Puberty | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617384/all/Precocious_Puberty?q=Meningitis

  In most populations, the mean ages of onset of puberty are 10.5 years in girls and 11.5 years in boys. […] Precocious puberty has traditionally been defined as physical signs of sexual development before age 8 years in girls and age 9 years in boys (2 to 2.5 standard deviations below the mean age of onset of puberty). […] Guidelines in 1999 by the Pediatric Endocrine Society proposed lowering the age considered to be normal for sexual development in girls to as young as age 6 years in African American girls and age 7 years in Caucasian girls. These guidelines have not been universally adopted. […] Occurs in ~1 in 5,000 children. […] Up to 10 times more common in girls than boys. […] In girls: 8090% of central precocious puberty is idiopathic. […] In boys: Precocious puberty is more likely to be associated with underlying pathology.

• #4

  https://step2.medbullets.com/pediatrics/422914/precocious-puberty

  precocious puberty is the appearance of pubertal development in children at a younger age than is considered normal (around 8 years for girls and 9 years for boys) […] Incidence: 1 in 5,000-10,000 children […] Demographics: 10:1 female-to-male ratio.

• #5 Precocious Puberty – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544313/

  Precocious puberty is classified into two major categories based on the etiology […] There are very limited studies describing the trends and prevalence of precocious puberty. The first epidemiologic study from a Danish national registry estimated that 0.2 % of females had some form of precocious puberty (CPP, PPP or benign variants) while it was less than 0.05% in males. There was female predominance about 20 to 23 per 10000 girls compared to boys, which were less than 5 per 10000 boys. […] Another observational study in Spain estimated the annual incidence of central precocious puberty to be between 0.02 and 1.07 cases per 100000 persons. […] A study looking into the Korean population estimated the prevalence of CPP to be 55.9 per 100000 girls and 1.7 per 100000 boys. The reported overall incidence of CPP in Koreans was 15.3 per 100000 girls, and 0.6 per 100000 boys. […] The prevalence and incidence vary significantly among different populations making it difficult to estimate definitive numbers.

• #6 Precocious Puberty: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/924002-overview

  The frequency of findings suggestive of precocious puberty in girls and boys depends on whether one is looking at genital hair or breast development, as well as the age at which the condition is considered precocious. The prevalence also depends on whether one is doing population-based screening or assessing the number of patients who are referred to specialists for evaluation. One of the very few studies looking at the prevalence and incidence of precocious puberty based on a national patient register was a Danish report covering the period 1993-2001. The investigators estimated the prevalence at about 0.2% of girls (0.8% for girls ages 5-9 years) and less than 0.05% of boys. […] In 1969, Marshall and Tanner published the results of their study of 192 White British girls, stating that the average age of thelarche was 11 years and defining precocious puberty in girls as commencing before age 8 years.

• #7 Epidemiology of precocious puberty – Primary Care Notebook

  https://primarycarenotebook.com/pages/diabetes-and-endocrinology/precocious-puberty-pseudo/epidemiology-of-precocious-puberty

  US observational data shows that at age 7, 10% of white girls and 23% of black girls have started puberty. […] European data approximately 5% of girls are thought to begin breast development before age 8. […] a registry based Danish study using ICD-10 diagnoses estimated prevalence of precocious puberty at 0.2% for girls and 0.05% of boys.

• #8 What Is the Physiology of Precocious Puberty?

  https://www.icliniq.com/articles/womens-health/physiology-of-precocious-puberty

  Studies describing the prevalence and trends of premature puberty are extremely rare. Precocious puberty was estimated to affect 0.2% of females and less than 0.05% of boys in the first epidemiologic study from a Danish national registry. Compared to guys, who made up less than 5 per 10,000 girls, there were roughly 20 to 23 more females than males. The annual incidence of central precocious puberty was estimated by another observational study to be between 0.02 and 1.07 cases per 100,000 people in Spain. According to a study of the Korean population, there are 1.7 cases of CPP for every 100,000 boys and 55.9 cases for every 100,000 girls. Incidence rates for CPP in Koreans were reported to be 15.3 per 100000 females and 0.6 per 100000 boys overall. […] It is challenging to estimate precise numbers due to the large population-specific variation in frequency and incidence.

• #9 Ongoing increasing trends in central precocious puberty incidence among Korean boys and girls from 2008 to 2020 | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0283510

  Over the last few decades, there has been growing evidence of earlier onset and progression of puberty worldwide. This population-based longitudinal cohort study aimed to analyze the change in the annual incidence rate of central precocious puberty (CPP) among Korean children over the most recent decade, using the national registry data. […] A total of 6,906 boys and 126,377 girls were diagnosed with CPP between 2008 and 2020. The annual incidence of CPP increased by 83.3 times in boys (from 1.2 to 100 per 100,000 persons) and by 15.9 times in girls (from 88.9 to 1414.7 per 100,000 persons). […] Based on GnRHa treatment insurance claims, our study suggests that the annual incidence of CPP has substantially increased in Korea during the past 13 years. These findings highlight the importance of meticulous judgment by doctors in determining GnRHa treatment.

• #10 Ongoing increasing trends in central precocious puberty incidence among Korean boys and girls from 2008 to 2020 | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0283510

  Few studies have been conducted to examine the prevalence of precocious puberty worldwide, as compared to several studies on normal pubertal timing and its secular changes among adolescents. Studies in Spain, Denmark, and Korea have reported an increase in CPP incidence. […] In this study, we aimed to examine the most up-to-date incidences of CPP in Korea and to determine if there was a difference in CPP trends based on sex and age group. […] The annual prevalence of CPP based on sex, calendar year, and two diagnostic age limits is shown in Table 3 and Fig 4. Between 2008 and 2020, the overall prevalence of CPP was 6.8 per 100,000 boys and 250.6 per 100,000 girls. Similar to the trend in incidence, the prevalence of CPP had increased annually and reached 28.0 per 100,000 boys and 657.2 per 100,000 girls by 2020.

• #11 A narrative review: treatment outcomes of central precocious puberty (CPP) – Ergun-Longmire – Pediatric Medicine

  https://pm.amegroups.org/article/view/6779/html

  Precocious puberty remains one of the most common indications for referral to pediatric endocrinology. […] Epidemiologic studies regarding the incidence of precocious puberty are limited. One study from Denmark reported that the prevalence of some form of precocious pubertal development was 0.2% in girls and less than 0.05% in boys. […] However, when inclusion criteria were limited to central precocious puberty (CPP) also called gonadotropin-dependent puberty, the incidence of CPP was 5.66 cases per million person-years at risk, with an annual incidence ranging between 0.02 and 1.07 new cases per 100,000. […] Overall, CPP is more common in girls with a female to male ratio of 10:1.

• #12 Precocious Puberty – Early Puberty: Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/21064-precocious-early-puberty

  Precocious puberty, or early puberty, means puberty that begins before age 8 in girls and before age 9 in boys. […] Early puberty affects about 20 out of every 10,000 children female children. It affects fewer than 5 in every 10,000 male children. […] Any child can develop precocious puberty. The condition happens more often in females than males. […] Precocious puberty tends to affect certain groups more often. Children who are at a higher risk of developing the condition include: Females, Children with overweight or obesity, Black children. […] Your childs outcome will depend on several factors, including: Bone age, Age of onset (how old they were when precocious puberty started), How quickly precocious puberty developed, Your childs treatment plan. […] You cant prevent most early puberty cases. Limiting your childs exposure to reproductive hormones from outside sources may prevent it.

• #13 Precocious Puberty – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/precocious-puberty

  The mean age for early breast development is about 9.5 to 10 years for White girls and 8.5 to 9 years for Black girls (range 8 to 13 years). […] The mean age for pubic hair growth is 9.5 years for Black girls and 10.5 years for White girls. […] However, the age of menarche has not lowered as drastically, with a mean decrease of only 3 months in the past 30 years (mean age 11.5 years in Black girls and 12.5 years in White girls). […] Precocious puberty can be divided into 2 types: GnRH-dependent (central precocious puberty) and GnRH-independent (peripheral sex hormone effects). […] GnRH-dependent precocious puberty is more common overall and 5 to 10 times more frequent in girls. […] In GnRH-dependent precocious puberty, the hypothalamic-pituitary axis is activated, resulting in enlargement and maturation of the gonads, development of secondary sexual characteristics, and oogenesis or spermatogenesis.

• #14 Precocious Puberty | 5-Minute Pediatric Consult

  https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/617384/all/Precocious_Puberty?q=Meningitis

  Only ~50% of boys have idiopathic central precocious puberty. […] Racial differences observed in girls: African American girls may enter puberty 1 year sooner on average than Caucasian girls; racial differences not present in males. […] Increased incidence in internationally adopted children and in children born premature or small for gestational age.

• #15 Precocious Puberty – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/precocious-puberty

  Precocious puberty is onset of sexual maturation before the average age. Diagnosis is by comparison with population standards, x-rays of the left hand and wrist to assess skeletal maturation and check for accelerated bone growth, and measurement of serum levels of gonadotropins and gonadal and adrenal steroids. Treatment depends on the cause. […] The definition of precocious puberty has traditionally been before age 8 in girls or age 9 in boys. However, the current definition depends on reliable population standards for onset of puberty (ie, when pubertal milestones occur); because onset is occurring earlier in the United States, especially in females, these traditional standards are being reevaluated. […] Racial and ethnic differences may also play a role, for example, early breast changes are noted in a higher percentage of Black girls (23.4% by age 7, 42.9% by age 8) compared to White girls (10.4% by age 7, 18.3% by age 8) and Hispanic girls (14.9% by age 7, 30.9% by age 8) (1).

• #16 Precocious Puberty: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/924002-overview

  No data were available to confirm this impression until 1997, when Herman-Giddens et al reported on the incidence of breast and pubic hair development by age and race in 17,000 US girls aged 3-12 years. They used the established definition that breast or pubic development in girls was precocious before age 8 years and estimated that approximately 8% of White and 25% of Black girls in the United States exhibited evidence of sexual precocity. […] Reliable estimates of the frequency of precocious puberty in boys have not been published. However, several centers have reported that they evaluate between one fifth and one tenth as many boys as girls for sexual precocity. Whether early puberty in boys is becoming more common over time, as is the case in girls, is unclear. However, a study from Denmark found that the mean age of testicular enlargement in boys declined from age 11.92 years to 11.66 years between 1991-1993 and 2006-2008, suggesting that more boys may be starting puberty before age 9 years.

• #17 Peripheral Precocious Puberty | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/27607

  Precocious puberty is defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys. […] Peripheral precocious puberty is less common than central precocious puberty. An Iranian case series estimated that 23.3% of cases of precocious puberty are due to peripheral causes. […] The incidence of precocious puberty is estimated to be between 1:5000 to 1:10,000. […] Overall, precocious puberty is 10 times more common in females than in males. […] Although the traditional age cut-off for precocious puberty is 8 years for girls and 9 years for boys, data from European studies indicate an overall decline in the age of onset of puberty in the past few decades. […] A multicenter study involving subjects in San Francisco, New York, and Cincinnati also confirmed this finding. […] The Lawson Wilkins Pediatric Endocrine Society (LWEPS) recommends evaluation if breast development or pubic hair appears before the age of 7 in Caucasian girls and 6 years in African American girls.

• #18 Disorders of Puberty: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p590.html

  Precocious puberty is pubertal onset before eight years of age in girls and before nine years of age in boys. […] Among patients with true precocious puberty, or full activation of the hypothalamic-pituitary-gonadal axis, most girls have an idiopathic etiology, whereas it is commonly due to identifiable pathology on imaging in boys. […] Precocious puberty is diagnosed when secondary sexual characteristics are identified in girls younger than eight years and boys younger than nine years. […] Data suggest a trend toward early pubertal development. […] Approximately 20% of black girls and 5% to 10% of white girls seven to eight years of age in the United States have glandular breast development, particularly if obese. […] Because of more frequent pathology in boys with precocious puberty than girls, all pubertal boys younger than nine years should be fully evaluated.

• #19 Precocious Puberty and Why it Matters | Columbia University Irving Medical Center

  https://www.cuimc.columbia.edu/news/precocious-puberty-and-why-it-matters

  Puberty is happening at younger and younger ages. […] A shift as dramatic as this has implications for health in the short and long term, including diabetes and risk of cancer, says pediatric endocrinologist Aviva Sopher, MD, associate professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons. […] Precocious puberty is an issue to be addressed. […] Puberty that starts earlier than these age ranges is called precocious puberty. […] Precocious puberty occurs 10 to 20 times more frequently among girls than boys. Currently, about four in 10 girls and people assigned female at birth undergo precocious puberty. […] Its easier to detect precocious puberty in girls, but about one in 10 boys and people assigned male at birth undergo precocious puberty, too.

• #20 Precocious Puberty: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/924002-overview

  A 2003 review of trends in timing of puberty around the world showed no clear progression toward earlier puberty in northern Europe. However, earlier mean age of menarche has been reported in some southern European countries and other warmer parts of the world. […] An interesting and still unexplained finding is the high incidence of precocious puberty in girls adopted into Western Europe from various underdeveloped countries. This has been studied extensively in Denmark, where the mean age at thelarche and at menarche in internationally adopted girls was significantly lower than that observed in a reference group of Danish-born girls.

• #21 Sedentary lifestyle and precocious puberty in girls during the COVID-19 pandemic: an Italian experience in: Endocrine Connections Volume 11 Issue 2 (2022)

  https://ec.bioscientifica.com/view/journals/ec/11/2/EC-21-0650.xml

  This retrospective study aimed to evaluate children observed for suspected precocious puberty in five Italian centers of Pediatric Endocrinology during the first wave of coronavirus disease 2019 pandemic (March-September 2020), compared to subjects observed in the same period of the previous year. […] Between March and September 2020, 338 subjects were referred for suspected precocious puberty, compared to 152 subjects in the same period of 2019 (+122%). The increase was observed in girls (328 subjects in 2020 vs 140 in 2019, P0.05), especially during the second half of the period considered (92 girls from March to May vs 236 girls from June to September); while no difference was observed in boys (10 subjects in 2020 vs 12 in 2019). The percentage of girls with confirmed CPP was higher in 2020, compared to 2019 (135/328 girls (41%) vs 37/140 (26%), P 0.01). […] The present findings corroborate the recently reported association between the complex lifestyle changes related to the lockdown and a higher incidence of CPP in Italian girls.

• #22

  https://link.springer.com/article/10.1007/s40618-023-02146-9

  The aim of our study was to compare the incidence of idiopathic central precocious puberty (CPP) in our highly specialized Endocrinological Center before and after the onset of COVID-19 lockdown; we also aimed to identify any potential difference between girls with CPP from the two different time periods. […] We registered an almost threefold increase in CPP incidence in the 20202021 period compared to the previous six years. […] Besides confirming a significant increase in new diagnoses of CPP in the post-lockdown period, our findings among Post-lockdown girls also suggest a less progressive form of CPP and a stronger environmental influence compared to genetic background in determining the timing of pubertal onset. […] Several Italian and international studies have observed that the incidence of new cases of Central Precocious Puberty (CPP) increased significantly during this period of restrictions, especially in female subjects.

• #23

  https://link.springer.com/article/10.1007/s40618-023-02146-9

  Like other Italian and foreign Centers previously did, we also have registered an increase in the incidence of idiopathic CPP: to be specific, an almost threefold increase from March 2020 to July 2021 compared to the pre-lockdown period (from 2014 to February 2020). […] In conclusion, our data confirmed an almost threefold increase in new diagnoses of CPP as of the beginning of lockdown compared to the previous six years, suggesting that during the pandemic the influence of genetics in determining the timing of pubertal onset has been scaled back in favor of a stronger environmental influence (the lockdown-effect).

• #24 Precocious Puberty – Pediatric Endocrine Society

  https://pedsendo.org/patient-resource/precocious-puberty/

  Precocious puberty is usually defined as onset of puberty before age 8 in girls and before age 9 in boys. […] It has been recognized that, on average, African American and Hispanic girls may start puberty somewhat earlier than white girls, so they may have an increased likelihood to have precocious puberty. […] When you see the doctor for concerns about early puberty, in addition to reviewing the growth chart and examining your child, certain other tests may be performed, including blood tests to check the pituitary hormones, which control puberty (luteinizing hormone, called LH, and follicle-stimulating hormone, called FSH) as well as sex hormone levels (estradiol or testosterone) and sometimes other hormones. […] If the blood tests show that your child has CPP, an MRI of the brain may be performed to make sure that there is no underlying abnormality in the area of the pituitary gland.

• #25

  https://www.archivesofmedicalscience.com/Central-precocious-puberty-etiology-with-particular-consideration-of-neurological,121051,0,2.html

  The etiology of CPP is very diverse. In girls, idiopathic CPP accounts for the vast majority of cases. However, recently the incidence of idiopathic cases has decreased due to the detection of gene mutations that lead to premature activation of the GnRH pulse generator. In boys, however, organic changes in the CNS are much more prevalent (40-75% of cases), which prompts imaging assessment of the CNS in each case of CPP among boys. In the female sex with CPP, organic CNS changes on MRI are reported in 0-27% of cases. However, they are more frequently detected in girls in whom secondary sexual characteristics occurred very early, i.e. below 6 years of age. Young age, rapid progression, and high estradiol concentrations are the factors that might predict increased risk of brain abnormalities.

• #26 A new efficient method to monitor precocious puberty nationwide in France | springermedizin.de

  https://www.springermedizin.de/a-new-efficient-method-to-monitor-precocious-puberty-nationwide-/15100804

  Clinical precocious puberty (PP) is a disease, reputed to be on the increase and suspected to be linked to endocrine disrupting chemicals (EDC) exposure. […] Population-based epidemiological data are lacking in France and scarce elsewhere. […] Very few epidemiologic data on PP are currently available in the world at the national scale. […] This is the first study describing a method to monitor the most frequent form of PP, idiopathic central PP (ICPP) nationwide in a cost-efficient way, using health insurance databases. […] This cost-effective method will allow to estimate and monitor the incidence of ICPP in France and to analyze spatial variations at a very precise scale, which will be very useful to examine the role of environmental exposures, especially to EDCs.

• #27 A new efficient method to monitor precocious puberty nationwide in France

  https://www.santepubliquefrance.fr/notices/a-new-efficient-method-to-monitor-precocious-puberty-nationwide-in-france

  Clinical precocious puberty (PP) is a disease, reputed to be on the increase and suspected to be linked to endocrine disrupting chemicals (EDC) exposure. Population-based epidemiological data are lacking in France and scarce elsewhere. […] We accessed the feasibility of monitoring PP nationwide in France in this context, using a nationwide existing database, the French National Health Insurance Information System. […] Conclusion: monitoring ICPP in France proved feasible using a Drug reimbursement indicator. Our method is cost efficient and highly relevant in public health surveillance.

• #28 JMIR Public Health and Surveillance – Long-Term Exposure to Fine Particulate Matter (PM2.5) Components and Precocious Puberty Among School-Aged Children: Cross-Sectional Study

  https://publichealth.jmir.org/2025/1/e62861

  Background: The increasing incidence of precocious puberty is a major health challenge for Chinese children, while related risk factors remain less well explored. […] Objective: Based on a cross-sectional survey covering 30 cities in 2017 to 2019, this study was designed to explore the association between long-term exposure to PM2.5 and its 5 major components with precocious puberty in China and to check the potential modifying effects of family-related and personal factors. […] Results: We found that the odds ratio (OR) for precocious puberty per IQR increase in the concentration of total PM2.5 mass was 1.27 (95% CI 0.92-1.75) for the whole population, 2.12 (95% CI 1.27-3.55) for girls, and 0.90 (95% CI 0.62-1.30) for boys. […] Conclusions: Long-term exposure to total PM2.5 mass was significantly associated with precocious puberty in girls, with organic matter identified as the major effect contributor.

• #29 JMIR Public Health and Surveillance – Long-Term Exposure to Fine Particulate Matter (PM2.5) Components and Precocious Puberty Among School-Aged Children: Cross-Sectional Study

  https://publichealth.jmir.org/2025/1/e62861

  This study explored the association between exposure to PM2.5 and its major components with precocious puberty based on a large survey of school-aged children in China. […] We observed that PM2.5 mass was significantly associated with precocious puberty only in girls. […] OM was detected as the major effective component when the 5 major components of PM2.5 were jointly exposed.

• #30

  https://journals.lww.com/10.1097/01.ede.0000392060.55344.46

  Central precocious puberty (CPP) is a complex problem with hypothalamic-pituitary-gonadal (HPG) axis for children development. This research is aimed to investigate the relationship and effect mechanism between phthalate exposure and girl puberty. […] In this study, we found MBP may affect puberty onset in girls by stimulating kisspeptin-54 secretion. Future researches are needed to elucidate the mechanism of action and to investigate whether any other factors related to DBP exposure alter the kisspeptin-54 secretion.

• #31

  https://www.nbcnews.com/health/womens-health/early-puberty-may-linked-common-chemical-used-personal-care-products-rcna169967

  The age when girls hit puberty has been falling at an alarming rate for decades, and scientists have struggled to explain why. […] Starting puberty significantly early younger than age 8 in girls, 9 in boys may have health effects lasting into adulthood, including higher risks of breast cancer, diabetes and heart disease. […] While the timing of puberty may depend at least partly on genetics, a rapid change points 100% to environmental factors, Shaw said. […] If Shaw and her team have found a compound that might affect when the brain sends the signal to begin puberty, they will also have discovered the mechanism at the root of the change in timing, which population studies haven’t been able to do. […] The new study is looking at a very important topic, said Dr. Apisadaporn Thambundit, a pediatric endocrinologist who is an assistant clinical professor of pediatrics at UCLA. […] However, I don’t think it’s strong enough to suggest anything that parents can do, she said. […] Based only on this study, it’s too early to consider banning or restricting a compound, McDonald said.

• #32 What Primary Care Providers Need to Know About Precocious Puberty – Pediatrics Nationwide

  https://pediatricsnationwide.org/2024/09/27/what-primary-care-providers-need-to-know-about-precocious-puberty/

  PCPs are the first line of defense in recognizing and referring possible cases of precocious puberty to endocrinologists for formal diagnosis and treatment. […] Precocious puberty — signs of the onset of puberty before the age of 8 in girls and 9 in boys — affects less than 1% of children in the United States, and is most common among females, children with obesity and African Americans. […] As members of Pediatric Endocrine Society’s Drugs and Therapeutics Committee, they surveyed pediatric endocrinologists across the country on the use of precocious puberty treatment modalities and monitoring practices, and the survey results were recently published. […] Early detection of precocious puberty and proactive referral to endocrinology can make a big difference in a child’s outcomes in these cases.

• #33 Clinical Management and Therapy of Precocious Puberty in the Sapienza University Pediatrics Hospital of Rome, Italy

  https://www.mdpi.com/2227-9067/10/10/1672

  Puberty identifies the transition from childhood to adulthood. Precocious puberty is the onset of signs of pubertal development before age eight in girls and before age nine in boys, it has an incidence of 1/5000–1/10,000 with an F:M ratio ranging from 3:1 to 20:1. […] There has been an increase in diagnoses of precocious puberty partly attributable to the SARS-CoV-2 pandemic, probably related to a sedentary lifestyle characterized by being overweight, the use of electronic devices and stress-related symptoms acting as endocrine disruptors. […] The family pediatrician plays a fundamental role in paying attention to pubertal development during normal health checks of the child, quickly referring a patient to a pediatric endocrinologist in case of pubertal activation signs, considering its increased prevalence in European countries.

• #34 Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study | Scientific Reports

  https://www.nature.com/articles/srep11208

  Early puberty timing is associated with higher risks for type 2 diabetes (T2D) and cardiovascular disease in women and therefore represents a potential target for early preventive interventions. […] In models adjusted for socioeconomic position and adiposity/body composition variables, both in women and men separately, earlier puberty timing was associated with higher risks for angina, hypertension and T2D. […] Notably, both early and late menarche were associated with higher risks for early natural menopause in women. […] Puberty timing in both men and women appears to have a profound impact on later health. […] We robustly confirm the associations between early puberty timing and T2D/cardiovascular disease in women, we describe very similar associations with early puberty timing in men and we implicate new links between puberty timing in both men and women and a wide range of health outcomes.

• #35 UK Biobank study finds timing of puberty has wide-ranging impacts on health in later life – MRC Epidemiology Unit

  https://www.mrc-epid.cam.ac.uk/blog/2015/06/18/timing-puberty-impacts-health/

  UK Biobank study finds timing of puberty has wide-ranging impacts on health in later life. Researchers from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge found that the age at which both men and women begin puberty is associated with 48 different health conditions. The study, published today in Scientific Reports, confirms previous findings that early puberty in women is a risk factor for heart disease and type 2 diabetes, and showed, for the first time, that early puberty in men also influences these same conditions. […] In addition, new links were found between the timing of puberty and a wider range of health conditions, including irritable bowel syndrome, arthritis, glaucoma, psoriasis and depression in men and women, and also early menopause in women.

• #36 Enrichment analyses of diseases and pathways associated with precocious puberty using PrecocityDB | Scientific Reports

  https://www.nature.com/articles/s41598-021-83446-z

  Pathway enrichment analysis of transcription factors of these genes led to identification of 45 statistically enriched pathways. […] Disease enrichment analysis revealed that reproductive, endocrine, metabolic and cancer-related disorders were enriched in PP. […] Pathway enrichment analysis using the PrecocityDB gene-set indicated that individuals with PP are at higher risk of developing reproductive and metabolic disorders such as PCOS, hypogonadism, insulin resistance, metabolic syndrome, glucose intolerance and hyperinsulinism. […] Pathways related to prostate cancer, breast, endometrial and hormone-dependent neoplasms were also found to be enriched in the PP gene-set.

• #37 Genetics study links early male puberty to shorter lifespan and darker hair colour – MRC Epidemiology Unit

  https://www.mrc-epid.cam.ac.uk/blog/2020/03/24/genetics-early-male-puberty-shorter-lifespan/

  Early puberty in boys is linked to a shorter lifespan and darker hair colour, according to the largest ever study of the genetics of male puberty, led by scientists at the University of Cambridge. […] The timing of puberty varies widely between individuals and is thought to be determined by a broad range of environmental and genetic factors. Early puberty has been associated with higher risks for a range of later life diseases, including several cancers, cardiovascular disease and type 2 diabetes. […] Researchers at the MRC Epidemiology Unit at the University of Cambridge used data from more than 200,000 men of white European ancestry collected by the UK Biobank Study and 23andMe to study the role that genetics plays in male puberty. […] The team also found that boys who hit puberty relatively earlier than their peers were at a greater risk of poor health later in life, corresponding to nine months shorter life for each year earlier started puberty.

• #38 Genetics study links early male puberty to shorter lifespan and darker hair colour – MRC Epidemiology Unit

  https://www.mrc-epid.cam.ac.uk/blog/2020/03/24/genetics-early-male-puberty-shorter-lifespan/

  The link between early puberty and shorter life expectancy may be partly explained by its negative impact on cardio-metabolic health and diseases such as Type 2 Diabetes. If so, then finding ways to prevent early puberty could help improve health in later life. […] The research was largely funded by the Medical Research Council.

• #39 Precocious puberty – Wikipedia

  https://en.wikipedia.org/wiki/Precocious_puberty

  Medical evaluation is sometimes necessary to recognize the few children with serious conditions from the majority who have entered puberty early but are still medically normal. […] One possible treatment is with anastrozole. […] Overall, puberty blockers have demonstrated an excellent safety and efficacy profile in the treatment of precocious puberty. […] Early puberty is posited to put girls at higher risk of sexual abuse; however, a causal relationship is, as yet, inconclusive. […] Early puberty also puts girls at a higher risk for teasing or bullying, mental health disorders and short stature as adults.

• #40 Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study | Scientific Reports

  https://www.nature.com/articles/srep11208

  In adjusted models, both in women and men separately, earlier puberty timing was associated with higher risks for angina, hypertension and T2D, while later puberty was associated with higher risks for asthma and self-rated poor overall health. […] Our findings substantially expand the range of associated adverse health outcomes, highlighting many with little or no prior link to age at menarche. […] Our findings do not indicate that avoidance or treatment of abnormal puberty timing will invariably have widespread beneficial consequences, but rather further work is needed to understand the possible psychosocial, adiposity-related and adiposity-independent mechanisms that link puberty timing to later life health outcomes.

• #41 Precocious puberty – Wikipedia

  https://en.wikipedia.org/wiki/Precocious_puberty

  In medicine, precocious puberty is puberty occurring at an unusually early age. […] Precocious puberty is of two types: true precocious puberty and pseudoprecocious puberty. […] A common definition for medical purposes is onset before 8 years in girls or 9 years in boys. […] Central precocious puberty can also be caused by brain tumors, infection (most commonly tuberculous meningitis, especially in developing countries), trauma, hydrocephalus, and Angelman syndrome. […] Precocious puberty is associated with advancement in bone age, which leads to early fusion of epiphyses, thus resulting in reduced final height and short stature. […] Studies indicate that breast development in girls and the appearance of pubic hair in both girls and boys are starting earlier than in previous generations.

• #42 Clinical Management and Therapy of Precocious Puberty in the Sapienza University Pediatrics Hospital of Rome, Italy

  https://www.mdpi.com/2227-9067/10/10/1672

  Regardless of the cause, PP must be promptly recognized since it is associated with accelerated stature growth and skeletal maturation if untreated, inducing an early growth arrest with premature epiphyseal fusion due to excess sex steroids, which sometimes results in short adult height. […] The main goal of this work is to display the standard clinical management and therapy of precocious puberty according to the experience and expertise of the pediatric endocrinology of Policlinico Umberto I, the Sapienza University of Rome, Italy where approximately 50 children and adolescents are treated each year, equally distributed between the sexes.

• #43 Disorders of Puberty: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p590.html

  In patients with precocious puberty, brain magnetic resonance imaging should be performed in girls younger than six years, all boys, and children with neurologic symptoms to evaluate for a central nervous system lesion. […] The initial workup should include measurement of serum FSH, LH, and testosterone in boys or estradiol in girls; thyroid function testing; and bone age radiography. […] The appropriate timing for neuroimaging to identify central nervous system lesions (e.g., hypothalamic hamartoma, malignancy) in children with precocious puberty is controversial. […] 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.

• #44 Precocious Puberty – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/precocious-puberty

  GnRH-independent precocious puberty is much less common. […] Diagnosis of precocious puberty is clinical. […] Diagnosis is made by bone age x-rays and measurement of LH and testosterone (in boys), and estradiol (in girls). […] Treat GnRH-dependent precocious puberty with the GnRH agonists leuprolide, triptorelin, or histrelin. […] Treat GnRH-independent precocious puberty based on the cause, including giving androgen or estrogen antagonists and removing tumors.

• #45 What Primary Care Providers Need to Know About Precocious Puberty – Pediatrics Nationwide

  https://pediatricsnationwide.org/2024/09/27/what-primary-care-providers-need-to-know-about-precocious-puberty/

  If families choose to treat precocious puberty with suppression, the drugs are very effective. If we start early enough, we can postpone puberty until the child is at a normal age for puberty, easing that process for the family emotionally and helping the child reach their optimal post-pubertal height. […] Children with earlier treatment have better outcomes, so we definitely do want PCPs to be watchful and refer early if they suspect something.

• #46

  https://www.archivesofmedicalscience.com/Central-precocious-puberty-etiology-with-particular-consideration-of-neurological,121051,0,2.html

  Central precocious puberty is a relatively rare disease. However, currently, there are too few studies on the prevalence of this disorder, the pathomechanism and the causes of CPP among children. It is confirmed that it accompanies many pathologies of the CNS and frequently coexists with neurological symptoms resulting from these abnormalities. Structural changes in the CNS associated with CPP are: hypothalamic hamartoma, arachnoid cyst, myelomeningocele, hydrocephalus, Chiari malformation, septo-optic dysplasia and tumors. Furthermore, cranial exposure to radiation, traumatic brain injury, neuroinfections, perinatal hypoxic-ischemic encephalopathy and some metabolic diseases are also risk factors for CPP. Safe and effective treatment is available. The time of treatment implementation is crucial to the successful outcome. Further studies are warranted to better analyze and understand the pathomechanism of CPP, including the identification of real risk factors for CPP in children.

• #47 New work examines importance of early life factors in pubertal development | HPHCI: Department of Population Medicine

  https://www.populationmedicine.org/news-media/new-work-examines-importance-early-life-factors-pubertal-development

  In a nationwide multi-cohort study, new work led by the Harvard Pilgrim Health Care Institute examined the importance of early life factors in pubertal development. […] Prior research indicates that early pubertal onset concerningly, on the rise in the United States and other countries- may increase risk of long-term chronic disease later in life. […] A better understanding of the early life factors related to puberty is important to develop intervention strategies to prevent earlier pubertal onset. […] Results showed that male children who gained weight or grew faster than their peers in the first five years of life were associated with entering puberty at a younger age. […] The researchers found similar results in female children but only among those with faster weight gains during early childhood (two to five years of age).

• #48 New work examines importance of early life factors in pubertal development | HPHCI: Department of Population Medicine

  https://www.populationmedicine.org/news-media/new-work-examines-importance-early-life-factors-pubertal-development

  Female children with faster weight gains during infancy (six months to two years of age) and early childhood started their periods earlier and had more advanced pubic hair development. […] Our findings suggest that there are sex-specific associations of faster growth in early life with earlier pubertal onset, said lead author Izzuddin Aris, PhD, Assistant Professor in the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School. […] Study results may also inform future studies that aim to develop or test interventions to help prevent earlier onset of puberty, such as good nutrition, environmental exposures, physical activity, and other behaviors related to growth during the first five years of life.

• #49 The Role of Pediatric Nutrition as a Modifiable Risk Factor for Precocious Puberty

  https://www.mdpi.com/2075-1729/11/12/1353

  Puberty is a critical phase of growth and development characterized by a complex process regulated by the neuroendocrine system. Precocious puberty (PP) is defined as the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal. The timing of puberty has important public health, clinical, and social implications. In fact, it is crucial in psychological and physical development and can impact future health. Nutritional status is considered as one of the most important factors modulating pubertal development. […] Nutritional status is considered one of the most important factors involved in pubertal development and it was estimated to explain as much as 25% of the variation in the timing of puberty. Early-life and childhood nutrition may have an impact on the timing of puberty onset. Several studies have proposed mechanisms by which energy imbalance, macro/micronutrient food content and dietary patterns may modulate the premature activation of the HPG axis, inducing PP.

• #50 The Role of Pediatric Nutrition as a Modifiable Risk Factor for Precocious Puberty

  https://www.mdpi.com/2075-1729/11/12/1353

  This narrative review presents an overview on the role of nutritional factors as determinants of the timing of sexual maturation, focusing on early-life and childhood nutrition. An increase in knowledge on the mechanism whereby nutrients may influence puberty will be useful in developing nutritional recommendations to maintain the regular timing of puberty. Adherence to adequate nutritional recommendations in pediatrics may contribute to preventing PP and related complications. […] The timing of puberty represents an important public health issue with clinical and social implications. Even though a major limitation of pubertal timing studies is that they are conducted cross-sectionally, so the possible changes in pubertal progression should be interpreted with caution before being confirmed by longitudinal studies, the literature supports the role of nutritional status and nutrients as determinants of the timing of sexual development. More than 20% of the variation in pubertal timing may be explained by the nutritional status during early life and childhood. This correlation can be related to rapid weight gain during infancy and childhood, but some effects are also independent of weight gain. Breast milk, the recommended form of nutrition from birth to six months, seems to have an important protective role against early puberty onset, mainly due to its positive influence on infant growth rate and childhood overweight prevention.

• #51 UK Biobank study finds timing of puberty has wide-ranging impacts on health in later life – MRC Epidemiology Unit

  https://www.mrc-epid.cam.ac.uk/blog/2015/06/18/timing-puberty-impacts-health/

  Though a cross-sectional study of this kind cannot distinguish between cause and effect, evidence from other studies using different methods does point to a causal link between puberty and certain diseases, such as type 2 diabetes. […] Dr John Perry, Senior Investigator Scientist at the MRC Epidemiology Unit, added: We are continuing to work to understand how puberty timing impacts later health and how this information may be used alongside efforts to support healthy lifestyle changes and prevent disease. […] It is important to note that the increase in disease risk attributable to puberty timing is still relatively modest and represents one of many factors that contribute to the overall risk of developing disease. […] The authors note that their consideration of a wide range of potential adverse health outcomes raised the possibility of spurious associations arising out of multiple testing.

• #52 Ongoing increasing trends in central precocious puberty incidence among Korean boys and girls from 2008 to 2020 | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0283510

  In conclusion, our research revealed that the reported increase in CPP incidence in Korea that began in early 2000 has continued through 2020. This phenomenon was ubiquitous across all age groups and both sexes, and was not confined to older children or girls. This suggests that the onset of puberty among the general population in Korea is shifting to the left. Further research is needed to identify the precise causes of accelerated puberty onset and to establish a new pubertal timing reference in Korea.

Zobacz więcej