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Minerva Pediatrica Dec 2020Precocious puberty (PP) is a common reason for referral to pediatric endocrinology clinics, with a strong female predominance. PP is a broad term encompassing benign... (Review)
Review
Precocious puberty (PP) is a common reason for referral to pediatric endocrinology clinics, with a strong female predominance. PP is a broad term encompassing benign variants of normal development, gonadotropin-dependent precious puberty (GDPP), and gonadotropin-independent precocious puberty (GIPP). This article reviews the definitions, physiology, clinical presentation, evaluation and treatment of these conditions.
Topics: Child; Female; Gonads; Humans; Hypothalamo-Hypophyseal System; Male; Puberty; Puberty, Precocious; Sex Factors
PubMed: 32748611
DOI: 10.23736/S0026-4946.20.05970-8 -
Indian Journal of Pediatrics Jun 2023Precocious puberty is a common presentation to pediatricians with a significant overlap between physiology and pathology. While most girls with precocious puberty have... (Review)
Review
Precocious puberty is a common presentation to pediatricians with a significant overlap between physiology and pathology. While most girls with precocious puberty have no identifiable cause, boys are more likely to have a pathological cause. The trend of earlier onset of thelarche with slow pubertal tempo has led to a significant increase in the number of girls presenting with precocious puberty. Advanced growth, bone age, uterine maturation, and elevated LH suggest rapidly progressive puberty. The critical issues in evaluating a child presenting with precocious puberty include its confirmation, exclusion of physiological variants, identification of the cause, and determining the need for treatment. Step-wise evaluation with emphasis on clinical parameters provides cost-effective assessment. Gonadotropin-releasing hormone (GnRH) analogs remain the mainstay of treatment for central precocious puberty but should be restricted to individuals with rapidly progressive puberty and compromised final height. The management of rarer forms of peripheral precocious puberty (McCune Albright syndrome, congenital adrenal hyperplasia, and testotoxicosis) involves using experimental drugs under the guidance of specialists.
Topics: Child; Male; Female; Humans; Puberty, Precocious; Gonadotropin-Releasing Hormone; Adrenal Hyperplasia, Congenital
PubMed: 37074536
DOI: 10.1007/s12098-023-04554-4 -
The Lancet. Diabetes & Endocrinology Mar 2016Central precocious puberty results from the premature activation of the hypothalamic-pituitary-gonadal axis. It mimics physiological pubertal development, although at an... (Review)
Review
Central precocious puberty results from the premature activation of the hypothalamic-pituitary-gonadal axis. It mimics physiological pubertal development, although at an inappropriate chronological age (before 8 years in girls and 9 years in boys). It can be attributable to cerebral congenital malformations or acquired insults, but the cause in most cases in girls remains unknown. MKRN3 gene defects have been identified in familial disease, with important basic and clinical results. Indeed, genetic analysis of this gene should be included in the routine clinical investigation of familial and idiopathic cases of central precocious puberty. Gonadotropin-releasing hormone agonists are the gold-standard treatment. The assessment and management of this disease remain challenging for paediatric endocrinologists. In this Series paper, we describe current challenges involving the precise diagnosis and adequate treatment of this disorder.
Topics: Child; Female; Gonadotropin-Releasing Hormone; Humans; Hypothalamo-Hypophyseal System; Male; Pituitary-Adrenal System; Puberty, Precocious; Ribonucleoproteins; Ubiquitin-Protein Ligases
PubMed: 26852255
DOI: 10.1016/S2213-8587(15)00380-0 -
BMJ (Clinical Research Ed.) Jan 2020
Review
Topics: Anthropometry; Counseling; Gonadotropins; Humans; Medical History Taking; Primary Health Care; Puberty, Precocious; Referral and Consultation
PubMed: 31932347
DOI: 10.1136/bmj.l6597 -
Best Practice & Research. Clinical... Aug 2018Central precocious puberty (CPP) results from early activation of the hypothalamic - pituitary -gonadal (HPG) axis and follows the same sequence as normal puberty. While... (Review)
Review
Central precocious puberty (CPP) results from early activation of the hypothalamic - pituitary -gonadal (HPG) axis and follows the same sequence as normal puberty. While many factors involved in pubertal initiation remain poorly understood, the kisspeptin system is known to play a key role. Currently, mutations in the kisspeptin system, MKRN3, and DLK1 have been identified in sporadic and familial cases of CPP. The diagnosis is based on physical exam findings indicating advancing puberty and on laboratory tests confirming central HPG axis activation. GnRH analogs are the mainstay of treatment and are used with the goal of height preservation. Newer extended release formulations continue to be developed. Currently there is no evidence of long-term complications associated with treatment. However, many areas remain to be explored such as targeted therapies and aspects of clinical management. Further investigation into psychological effects and additional data regarding long-term outcomes, particularly in males, is needed.
Topics: Calcium-Binding Proteins; Child; Female; Gonadotropin-Releasing Hormone; Humans; Intercellular Signaling Peptides and Proteins; Kisspeptins; Male; Membrane Proteins; Mutation; Puberty, Precocious; Ribonucleoproteins; Ubiquitin-Protein Ligases
PubMed: 30086862
DOI: 10.1016/j.beem.2018.05.008 -
Frontiers in Endocrinology 2022During the year 2020, the COVID-19 pandemic rapidly became a severe health emergency worldwide. In order to contrast the spread of the novel SARS-CoV-2, many countries... (Review)
Review
During the year 2020, the COVID-19 pandemic rapidly became a severe health emergency worldwide. In order to contrast the spread of the novel SARS-CoV-2, many countries implemented extraordinary restrictive measures, such as a strict lockdown and school closures. The pandemic had a great impact on children and adolescents' daily life, leading to a much more sedentary lifestyle, to larger use of electronic devices and to an increase in stress-related symptoms. These conspicuous changes acted as disruptors of children's normal development. Since the beginning of the pandemic, many studies reported an increase in the number of precocious puberty cases as well as a faster progression rate of puberty itself, if compared to the pre-pandemic years. In this review, our aim was to evaluate the incidence of new cases of early and precocious puberty during the COVID-19 pandemic, analyzing variations in the timing of puberty and in pubertal progression rate, and to investigate the role of environmental and lifestyle factors during the pandemic in modulating the physiopathology of pubertal development. While a direct effect of SARS-CoV-2 infection remains, at the moment, a remote hypothesis, both physical and psychological factors related to the pandemic seem to have a role in triggering GnRH pulsatile secretion leading to earlier pubertal onset. It is indeed important to stress the need to clarify the exact role of COVID-19 in early pubertal onset comparing data from all over the world; long-term comprehensive studies are also pivotal to explain whether this phenomenon will continue while we resume pre-pandemic habits.
Topics: Child; Adolescent; Humans; Puberty, Precocious; COVID-19; Pandemics; SARS-CoV-2; Communicable Disease Control
PubMed: 36699035
DOI: 10.3389/fendo.2022.1107911 -
The Lancet. Child & Adolescent Health Dec 2023Central precocious puberty (CPP) refers to early activation of the hypothalamic-pituitary-gonadal (HPG) axis and is manifested by breast development in girls or... (Review)
Review
Central precocious puberty (CPP) refers to early activation of the hypothalamic-pituitary-gonadal (HPG) axis and is manifested by breast development in girls or testicular enlargement in boys before the normal physiological age ranges. CPP can be precipitated by intracranial pathology, exposure to high levels of sex steroids, or environmental risk factors, but most cases are idiopathic. Monogenic causes have also been identified. In this Review, we summarise pathophysiology, risk factors, diagnosis, and management of CPP. Concern for CPP should prompt referral to paediatric endocrinology where diagnosis is confirmed by clinical, biochemical, radiological, and genetic testing. CPP is treated with a gonadotropin-releasing hormone analogue, the primary aims of which are to increase adult height and postpone development of secondary sexual characteristics to an age that is more commensurate with peers. Although long-term outcomes of treatment with gonadotropin-releasing hormone analogues are reassuring, additional research on the psychological effect of CPP is needed.
Topics: Adult; Child; Female; Humans; Male; Gonadotropin-Releasing Hormone; Puberty, Precocious
PubMed: 37973253
DOI: 10.1016/S2352-4642(23)00237-7 -
The New England Journal of Medicine May 2008
Review
Topics: Age Determination by Skeleton; Child; Female; Gonadal Steroid Hormones; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Medical History Taking; Puberty, Precocious
PubMed: 18509122
DOI: 10.1056/NEJMcp0800459 -
Journal of Clinical Research in... 2009This review describes several aspects of the management of precocious puberty (PP) and variants in girls and boys. PP is characterized by early pubertal changes,... (Review)
Review
This review describes several aspects of the management of precocious puberty (PP) and variants in girls and boys. PP is characterized by early pubertal changes, acceleration of growth velocity and rapid bone maturation that often result in reduced adult height. Onset of pubertal signs before the age of 8 years in girls and 9 years in boys should always be evaluated carefully. The main principles of therapy are to stop the progression of secondary sex characteristics and menses (in girls), to increase final adult height, to promote psychosocial well-being, and to treat the underlying cause if known.
Topics: Breast; Child; Female; Gonadotropins; Humans; Hypothyroidism; Male; Puberty; Puberty, Precocious; Reference Values
PubMed: 21274291
DOI: 10.4274/jcrpe.v1i4.3 -
Pediatric Endocrinology Reviews : PER Jan 2006The term precocious puberty encompasses a group of heterogeneous conditions that range from variants of normal to slowly progressive and rapidly progressive maturation... (Review)
Review
The term precocious puberty encompasses a group of heterogeneous conditions that range from variants of normal to slowly progressive and rapidly progressive maturation of both sexes. It is defined as the appearance of secondary sex characteristics before the age of 8 in girls and 9 in boys. The clinician who is evaluating a child with precocious puberty should be aware of the normal events of puberty, the ages at which pubertal milestones are achieved and the tempo of pubertal progression. The mechanisms involved in the onset and progression of normal puberty are briefly discussed in this article. The diverse etiology of precocious puberty, the diagnostic evaluation of the patient including clinical, laboratory and radiological investigation as well as problems associated with precocious puberty and indications for treatment and treatment modalities are further discussed in the article.
Topics: Animals; Body Height; Bone and Bones; Child; Estrogen Receptor Modulators; Female; Gonadotropin-Releasing Hormone; Humans; Leptin; Male; Puberty, Precocious; Rats; Receptors, G-Protein-Coupled
PubMed: 16641856
DOI: No ID Found