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Minerva Medica Jun 2006Premature thelarche is usually considered a benign condition that disappears without influencing statural growth nor the timing of puberty. It is generally held a... (Review)
Review
Premature thelarche is usually considered a benign condition that disappears without influencing statural growth nor the timing of puberty. It is generally held a phenomenon of endogenous origin but exposure to oestrogenic pollutants must also be taken into consideration since environmental and epidemiological studies have shown that humans and some animal species are adversely affected by environmental chemical substances that interfere with the endocrine system and are known as endocrine disrupters. Environmental pollutants acting as endocrine disrupters include oestrogens and oestrogen-like products that are universally present in the form of hormones used in stockbreeding, chemicals employed in industry and agriculture, and substances naturally contained in plants and cereals. So far few studies have examined the influence of exogenous oestrogenic or oestrogen-like substances in premature thelarche, and there have been equally few reports of the occurrence of many cases in a circumscribed environment and a limited period of time. Since many agents are in a position to make a contribution to the biological mechanisms underlying thelarche, there is no easy way of determining the role of a given substance in the onset of the clinical picture. Furthermore, it must not be forgotten that both the metabolic clearance rate and the serum levels of oestradiol in healthy prepubertal children are still uncertain and even very low doses of exogenous steroid hormones might thus have significant biological effects. Aim of the work is to underline the importance of the exposure to oestrogenic environmental pollutants as possible cause of premature thelarche.
Topics: Breast; Breast Diseases; Child; Endocrine Disruptors; Estrogens; Female; Humans; Pesticides; Phenols; Phytoestrogens; Testosterone
PubMed: 16855522
DOI: No ID Found -
American Journal of Medical Genetics Apr 2002
Review
Topics: Breast; Child, Preschool; Female; Humans; Infant; Puberty, Precocious; Rubinstein-Taybi Syndrome
PubMed: 11932997
DOI: 10.1002/ajmg.10297 -
Current Therapy in Endocrinology and... 1997
Review
Topics: Breast; Breast Diseases; Child; Female; Gonadotropin-Releasing Hormone; Growth Hormone; Humans; Male; Puberty, Precocious
PubMed: 9174689
DOI: No ID Found -
European Journal of Pediatrics Oct 2021The classic definition of precocious sexual maturation is the development of secondary sexual characteristics before 8 years of age in girls and before 9 years of age in... (Review)
Review
The classic definition of precocious sexual maturation is the development of secondary sexual characteristics before 8 years of age in girls and before 9 years of age in boys. It is classified as central precocious puberty when premature maturation of the hypothalamic-pituitary-gonadal axis occurs, and as peripheral precocious puberty when there is excessive secretion of sex hormones, independent of gonadotropin secretion. Precocious sexual maturation is more common in girls, generally central precocious puberty of idiopathic origin. In boys, it tends to be linked to central nervous system abnormalities. Clinical evaluation should include a detailed history and physical examination, including anthropometric measurements, calculation of growth velocity, and evaluation of secondary sexual characteristics. The main sign to suspect the onset of puberty is breast tissue development (thelarche) in girls and testicular enlargement (≥4 mL) in boys. Hormonal assessment and imaging are required for diagnosis and identification of the etiology. Genetic testing should be considered if there is a family history of precocious puberty or other clinical features suggestive of a genetic syndrome. Long-acting gonadotropin-releasing hormone analogs are the standard of care for central precocious puberty management, while peripheral precocious puberty management depends on the etiology.Conclusion: The aim of this review is to address the epidemiology, etiology, clinical assessment, and management of precocious sexual maturation. What is Known: • The main sign to suspect the onset of puberty is breast tissue development (thelarche) in girls and testicular enlargement (≥4 mL) in boys. The classic definition of precocious sexual maturation is the development of secondary sexual characteristics before 8 years of age in girls and before 9 years of age in boys. • Long-acting gonadotropin-releasing hormone agonist (GnRHa) is the standard of care for CPP management, and adequate hormone suppression results in the stabilization of pubertal progression, a decline in growth velocity, and a decrease in bone age advancement. What is New: • Most cases of precocious sexual maturation are gonadotropin-dependent and currently assumed to be idiopathic, but mutations in genes involved in pubertal development have been identified, such as MKRN3 and DLK1. • A different preparation of long-acting GnRHa is now available: 6-month subcutaneous injection.
Topics: Child; Female; Gonadotropin-Releasing Hormone; Humans; Male; Puberty; Puberty, Precocious; Sexual Maturation; Ubiquitin-Protein Ligases
PubMed: 33745030
DOI: 10.1007/s00431-021-04022-1 -
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 -
Journal of Pediatric and Adolescent... Dec 2011The aim of this study was to measure the prevalence of premature thelarche in infant and toddler girls and to determine if environmental sources of estrogen were...
STUDY OBJECTIVE
The aim of this study was to measure the prevalence of premature thelarche in infant and toddler girls and to determine if environmental sources of estrogen were associated with early breast development.
DESIGN
Observational with mixed methods: Retrospective chart review, cross-sectional component involving an interview survey, along with longitudinal follow-up of girls with thelarche up to six months.
SETTING
A general pediatric clinic within a teaching hospital located in a large Midwestern city.
PARTICIPANTS
Girls, between the ages of 12 and 48 months, and their mothers, presenting for well-child care.
INTERVENTIONS
None.
MAIN OUTCOME MEASURES
Prevalence of premature thelarche; association of premature thelarche with selected environmental exposures.
RESULTS
Among the 318 subjects, the overall prevalence of premature thelarche was measured at 4.7% (n = 15). The prevalence by race/ethnicity was 4.2% among White Non-Hispanics, 4.6% among Blacks and 6.5% among White Hispanics. The peak prevalence occurred between 12-17 months of age. All thelarche cases were Tanner stage 2. No statistically significant relationship was found between premature thelarche and environmental exposures. Upon follow-up, 44% of the cases of premature thelarche had persistent breast development.
CONCLUSIONS
Our study demonstrated a higher prevalence of premature thelarche than has been previously reported. This study lacked power because of the small number of premature thelarche cases, the ubiquitous presence of environmental exposure as well as the potentially small effect of each environmental factor. Future studies need to employ a very large sample in order to accurately analyze the relationship between environmental toxicants and premature thelarche.
Topics: Black People; Breast; Child, Preschool; Cross-Sectional Studies; Environmental Exposure; Female; Follow-Up Studies; Humans; Infant; Prevalence; Puberty, Precocious; Retrospective Studies; White People
PubMed: 22099730
DOI: 10.1016/j.jpag.2011.01.003 -
Gynecological Endocrinology : the... Aug 1996The differentiation between premature thelarche and idiopathic central precocious puberty is essential for both long-term prognosis and therapeutic approach but, until...
The differentiation between premature thelarche and idiopathic central precocious puberty is essential for both long-term prognosis and therapeutic approach but, until now, there have been insufficient data to predict the future of the girls with premature thelarche. We studied 46 girls with premature thelarche longitudinally. The girls were subdivided into two groups according to the time of onset of thelarche: Group A consisted of 26 girls who presented thelarche before the second year of life (mean +/- SD 14.7 +/- 5.2 months) and Group B contained 20 girls who showed breast enlargement after the second year of life (5.7 +/- 3.1 years). The mean basal follicle-stimulating hormone (FSH) level of the patients as a whole was significantly higher than normal values (2.1 +/- 0.05 vs. 0.7 +/- 0.9 mIU/ml, p < 0.01) and the luteinizing hormone (LH) level was not significantly different from that in healthy control subjects (0.8 +/- 0.6 vs. 0.6 +/- 0.7 mIU/ml). After gonadotropin-releasing hormone test the FSH response was significantly higher than normal prepubertal values (12.9 +/- 2.1 vs. 3.9 +/- 2.9 mIU/ml, p < 0.001) whereas the LH response did not differ significantly (1.8 +/- 0.6 vs. 1.7 +/- 0.9 mIU/ml). After a follow-up time ranging from 5.1 to 7.8 years (mean +/- SD 5.9 +/- 1.9) we observed a greater percentage of disappearance in the girls in Group A than in those in Group B. The present data show that the percentage of girls who developed precocious puberty was significantly higher when they presented thelarche after the age of 2 years than before; the age of onset of thelarche can be useful to distinguish patients at risk of progressing towards precocious puberty.
Topics: Adolescent; Adrenal Glands; Age of Onset; Breast; Child; Child, Preschool; Cohort Studies; Estradiol; Female; Follicle Stimulating Hormone; Follow-Up Studies; Genitalia, Female; Humans; Infant; Longitudinal Studies; Luteinizing Hormone; Ovary; Prolactin; Puberty, Precocious; Risk Factors; Ultrasonography
PubMed: 8908524
DOI: 10.3109/09513599609012315 -
Obstetrics and Gynecology Jun 2017Premature thelarche is a self-limited condition characterized by Tanner stage II-III breast development in girls younger than 8 years of age with no evidence of...
BACKGROUND
Premature thelarche is a self-limited condition characterized by Tanner stage II-III breast development in girls younger than 8 years of age with no evidence of advancing puberty. Evaluation concentrates on excluding central or peripheral causes of precocious puberty.
CASE
A girl aged 2 years 4 months with profound hypotonia and delayed developmental milestones presented with Tanner II breast development, elevated follicle-stimulating hormone levels, suppressed luteinizing hormone level, normal growth and skeletal development, and prepubertal uterine length and ovarian volume. Monitoring until 8 years of age revealed no pubertal progression. Whole exome sequencing at 8 years revealed an autosomal-dominant mutation in the purine-rich element-binding protein A (PURA) gene. Previous patients with PURA syndrome have had pituitary dysfunction and precocious puberty.
CONCLUSION
Purine-rich element-binding protein A syndrome can be associated with premature thelarche.
Topics: Breast; Child, Preschool; DNA-Binding Proteins; Diagnosis, Differential; Female; Gonadotropins, Pituitary; Humans; Puberty, Precocious; Syndrome; Transcription Factors
PubMed: 28486374
DOI: 10.1097/AOG.0000000000002047