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Archives of Disease in Childhood Aug 1998There is a debate about the possible progression of idiopathic premature thelarche towards precocious or early puberty.
BACKGROUND
There is a debate about the possible progression of idiopathic premature thelarche towards precocious or early puberty.
OBJECTIVE
To evaluate height and age at onset of puberty in a group of girls with a history of idiopathic premature thelarche.
STUDY DESIGN
The height and age at onset of puberty of 42 girls now over 10 years of age who were diagnosed with isolated premature thelarche before the age of 3 years were evaluated.
RESULTS
Menarche was reached before or at 11 years of age in 13.5% of this group of girls. This percentage of early menarche was higher than would be expected from historical controls in the general population, but was consistent with maternal age of menarche. The mean (SD) height of the girls (n = 15) who achieved adult height was 162.9 (6.3) cm, which was slightly higher than the mean (SD) relative mid-parental height (160.7 (6.7) cm).
CONCLUSIONS
Isolated premature thelarche with onset before 3 years of age progresses towards precocious puberty, although this was consistent with the maternal age of menarche. Furthermore, adult height was normal when compared with population norms in all patients.
Topics: Adolescent; Adult; Age Factors; Body Height; Breast; Child; Female; Humans; Menarche; Mothers; Prognosis; Puberty, Precocious
PubMed: 9797603
DOI: 10.1136/adc.79.2.173 -
Isolated premature thelarche and thelarche variant: clinical and auxological follow-up of 119 girls.Journal of Endocrinological... Mar 1998Age of thelarche presentation, breast evolution, growth and puberty patterns were retrospectively evaluated in 119 girls with premature thelarche (PT). Thelarche... (Clinical Trial)
Clinical Trial
Age of thelarche presentation, breast evolution, growth and puberty patterns were retrospectively evaluated in 119 girls with premature thelarche (PT). Thelarche spontaneously presented before 2 yr of chronological age in 80% of girls and completely regressed in 60% of them. Breast regression was significantly more frequent in the patients with more precocious thelarche presentation. In 40% of the girls breast size did not significantly change during a follow-up period ranging from 12 to 134 months (40.6 +/- 32.5). Among the 38 girls who were followed up to an age greater than 8 yr, seven (18.4%) developed central precocious puberty (PP). These 7 patients who progressed into true PP were indistinguishable from girls with normal puberty for age of thelarche presentation, breast size, evolution and auxological features. On the contrary, a subgroup of patients (28.5%) with accelerated height velocity and/or bone age at diagnosis of PT showed an auxological pattern different from normally growing girls during a 3-yr follow-up, but they did not seem to have higher risk of progressing into precocious puberty. In conclusion, PT encompasses different clinical, and perhaps hormonal situations, therefore requiring careful clinical follow-up.
Topics: Aging; Breast; Child; Child, Preschool; Female; Humans; Infant; Menarche; Puberty, Precocious; Sexual Maturation
PubMed: 9591214
DOI: 10.1007/BF03347298 -
Clinical Endocrinology Feb 2005Inhibin B is produced by granulosa cells in small antral follicles, under the influence of FSH, and has a paracrine role in oestradiol synthesis. To test the hypothesis... (Comparative Study)
Comparative Study
OBJECTIVE
Inhibin B is produced by granulosa cells in small antral follicles, under the influence of FSH, and has a paracrine role in oestradiol synthesis. To test the hypothesis that premature thelarche is associated with increased FSH-driven follicular development, we measured inhibin B and FSH in girls with premature thelarche, girls with central precocious puberty (CPP) and controls matched either for age or breast stage.
PATIENTS
Blood samples were collected from 11 girls with premature thelarche (breast stage 2, aged 0.4-5.6 years), 11 prepubertal controls age-matched to the thelarche girls (0.5-5.4 years), 13 girls with CPP (breast stage 2, 3.9-8.2 years) and nine normal pubertal controls (breast stage 2, 9.0-13.2 years).
MEASUREMENTS
Dimeric inhibin B was measured in plasma by double-antibody enzyme-linked immunoassay and FSH by immunoradiometric assay. Pelvic ultrasonography was performed on all girls with CPP and 10/11 girls with premature thelarche.
RESULTS
Seven of the 13 girls with CPP and three of the eight girls with premature thelarche whose ovaries could be visualized had visibly nonhomogeneous ovarian structure on ultrasonography. Girls with premature thelarche had inhibin B and FSH concentrations higher than those in their age-matched controls (P < 0.01 and P < 0.05, respectively), and similar to those observed in girls with CPP and normal pubertal controls matched for breast stage. In thelarche girls, as in precocious puberty girls and normal pubertal controls, inhibin B and FSH were positively related (rs = 0.54-0.61).
CONCLUSIONS
This study provides further evidence that premature thelarche is associated with enhanced follicular development, similar to that which occurs in early puberty, probably under the influence of FSH.
Topics: Breast; Breast Diseases; Case-Control Studies; Child; Female; Follicle Stimulating Hormone; Humans; Inhibins; Ovary; Puberty; Puberty, Precocious; Statistics, Nonparametric
PubMed: 15670197
DOI: 10.1111/j.1365-2265.2004.02198.x -
The Journal of Pediatrics Feb 1999Estradiol levels in girls with premature thelarche have not previously been well defined because of the lack of adequate sensitivity of previously available estradiol... (Comparative Study)
Comparative Study
OBJECTIVE
Estradiol levels in girls with premature thelarche have not previously been well defined because of the lack of adequate sensitivity of previously available estradiol assays. The ultrasensitive recombinant cell bioassay for estradiol has made the study of estradiol levels in premature thelarche possible. We hypothesized that girls with premature thelarche have higher estradiol levels than normal prepubertal girls.
STUDY DESIGN
We used an ultrasensitive recombinant cell bioassay to study estradiol levels in 20 girls with premature thelarche and 15 normal prepubertal girls less than 3 years of age. The 2 groups were compared by Student t test.
RESULTS
Estradiol levels were significantly greater in the girls with premature thelarche (8.4 4. 5 pmol/L estradiol equivalents) than in the normal prepubertal girls (3.3 3.5 pmol/L estradiol equivalents; P <.01). The estradiol level was not significantly correlated with age, height, weight, body mass index, age at onset of thelarche, or the presence or absence of ovarian cysts.
CONCLUSION
Girls with premature thelarche have significantly higher estradiol levels than normal prepubertal girls. This is consistent with the hypothesis that the mechanism of premature thelarche involves increased estradiol levels rather than increased sensitivity of breast tissue to normal estradiol levels.
Topics: Biological Assay; Breast; Estradiol; Female; Humans; Infant; Puberty, Precocious
PubMed: 9931528
DOI: 10.1016/s0022-3476(99)70414-2 -
Environmental Toxicology and... Apr 2018In girls, breast development before eight years of age is called "premature thelarche (PT)". There are few studies in literature that show the interaction between PT and...
In girls, breast development before eight years of age is called "premature thelarche (PT)". There are few studies in literature that show the interaction between PT and phthalate exposure. The aim of this study was to determine the urinary levels of di-(2-ethylhexyl) phthalate (DEHP) metabolites and other phthalate metabolites in girls with PT. PT group consisted of 29 newly diagnosed subjects. Control group comprised of healthy age-matched girls (n = 25). Urinary phthalate metabolite concentrations were measured by liquid chromatography/tandem mass spectroscopy (LC-MS/MS). The urinary concentrations of mono-(2-ethyl-hexyl)phthalate (MEHP) in the PT group (33.96 ± 6.88 μg/g creatinine) were found to be significantly higher compared to control group (11.54 ± 1.39 μg/g creatinine, p = 0.002). In PT group, %MEHP was also markedly higher vs. control (17.84 ± 3.31 vs. 6.44 ± 1.13, p = 0.001). Our results suggest that DEHP is more efficiently converted to MEHP in girls with PT, the importance of which needs to be further elucidated.
Topics: Child; Child, Preschool; Creatinine; Endocrine Disruptors; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Phthalic Acids; Puberty, Precocious
PubMed: 29625387
DOI: 10.1016/j.etap.2018.03.010 -
Journal of the Medical Association of... Nov 1999Premature thelarche (PT) is characterized by isolated breast development in girls prior to 8 years of age. In addition, there is neither growth spurt nor advanced bone...
Premature thelarche (PT) is characterized by isolated breast development in girls prior to 8 years of age. In addition, there is neither growth spurt nor advanced bone age. It has been suggested that luteinizing hormone (LH) response to gonadotropin-releasing hormone (GnRH) alone is adequate to distinguish central precocious puberty from PT. However, LH response to GnRH is greater in infancy than that in childhood. Therefore, gonadotropin response to GnRH in girls with isolated premature breast development in different age group was studied. Thirty-six girls with isolated PT (aged 0.25-8 years) were evaluated. They were classified into 2 groups; aged < 4 years (group A: mean age 1.57 +/- 0.87 years, n = 13) and > or = 4 years (group B: mean age 6.97 +/- 0.94 years, n = 23). Initial evaluation included X-ray bone age, pelvic sonography and GnRH testing. Patients were followed for at least 1 year to confirm that no patient had progression into puberty. Bone ages in both groups were within mean +/- 2 SD in all patients. Pelvic sonography was performed in all patients which revealed no abnormality of ovaries and uterus. Pubertal response to GnRH stimulation is characterized by peak LH of > 20 IU/L or delta LH of > 15 IU/L which is generally greater than peak follicle stimulating hormone (FSH) or delta FSH, respectively. Mean peak LH and delta LH in group A were 13.0 +/- 6.06 and 11.4 +/- 5.92 IU/L whereas those in the group B were 8.5 +/- 4.10 and 6.3 +/- 3.49 IU/L. Therefore, LH response to GnRH in group A was significantly higher than that in group B (p < 0.05). In addition, the mean peak FSH and delta FSH in group A were 120.5 +/- 45.87 and 109.9 +/- 42.09 IU/L whereas those in the group B were 48.7 +/- 24.05 and 39.9 +/- 23.69 IU/L. Therefore, FSH response to GnRH in group A was significantly greater than that in group B (p < 0.001). LH response to GnRH alone can distinguish prepuberty from puberty in girls > 4 years of age. However, in prepubertal young girls with PT aged < 4 years, pubertal LH response can occur, i.e. peak LH > 20 IU/L. Hence, the greater FSH response to GnRH than that of LH would confirm the diagnosis of premature thelarche in this group. Therefore, the evaluation of FSH response to GnRH is beneficial to distinguish puberty from prepuberty in young girls.
Topics: Child; Child, Preschool; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infant; Luteinizing Hormone; Puberty, Precocious
PubMed: 10730515
DOI: No ID Found -
Journal of Child and Adolescent... May 2014
Topics: Antipsychotic Agents; Breast; Child; Female; Humans; Psychotic Disorders; Puberty, Precocious; Risperidone; Time Factors
PubMed: 24840046
DOI: 10.1089/cap.2014.2442 -
Gynecological Endocrinology : the... Oct 2017Premature thelarche (PT) is a benign, nonprogressive condition defined as isolated breast development. While the pathophysiology of PT remains unclear, increased...
OBJECTIVE
Premature thelarche (PT) is a benign, nonprogressive condition defined as isolated breast development. While the pathophysiology of PT remains unclear, increased sensitivity to estrogen may cause PT. The aim of this study was to investigate the association between polymorphisms in the estrogen receptor alpha (ERα) gene and PT in girls.
METHODS
In this case-control study, we examined 96 girls referred for early breast development (before the age of 8 years). The control group included healthy Korean females with normal pubertal progression. Anthropometric and hormonal parameters were measured and PvuII and XbaI ERα gene polymorphisms were evaluated by PCR. Out of the 96 girls, all coding exon and exon-intron boundaries of ERα were sequenced from the DNA of 46 girls.
RESULTS
There was no significant difference in the distribution of PvuII and XbaI polymorphisms between patients and controls. However, the carriers of XbaI polymorphisms had more advanced Tanner stage than did the non-carriers. Also, four ERα gene polymorphisms were previously identified, but these polymorphisms had no clinical significance.
CONCLUSION
No association was found between the ERα gene polymorphisms and PT in girls. However, XbaI polymorphisms may contribute to early breast budding.
Topics: Breast; Case-Control Studies; Child; DNA-Cytosine Methylases; Deoxyribonucleases, Type II Site-Specific; Estrogen Receptor alpha; Female; Gene Frequency; Genetic Association Studies; Genetic Predisposition to Disease; Humans; Polymorphism, Restriction Fragment Length; Puberty, Precocious
PubMed: 28440677
DOI: 10.1080/09513590.2017.1318374 -
Frontiers in Endocrinology 2021The gonadotropin-releasing hormone (GnRH) stimulation test is the benchmark for diagnosing precocious puberty (PP). However, it is invasive, time-consuming, costly, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The gonadotropin-releasing hormone (GnRH) stimulation test is the benchmark for diagnosing precocious puberty (PP). However, it is invasive, time-consuming, costly, and may create an unpleasant experience for participants. Moreover, some overlaps may occur between PP and premature thelarche (PT) in the early stage of PP. Female pelvic ultrasonography may provide additional information to help differentiate PP from PT and subsequently initiate early treatment. In this study, we aimed to first directly compare pelvic ultrasonography parameters between PP and PT groups and secondly, investigate their diagnostic accuracy compared with the GnRH stimulation test.
METHODS
A systematic search of the PubMed/MEDLINE, EMBASE, Scopus, and Cochrane Library databases was performed up to March 31, 2021. All types of studies, except for case reports and review articles, were included. The GnRH stimulation test was used to confirm PP diagnosis. Those whose organic conditions might cause PP were excluded. The mean, standard deviation, sensitivity, and specificity of each parameter were documented. Forest plots were constructed to display the estimated standardized mean differences (SMDs) from each included study and the overall calculations. A bivariate model was used to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR).
RESULTS
A total of 13 studies were included for analysis. The SMDs (95% confidence interval - CI) in ovarian volume, fundal-cervical ratio, uterine length, uterine cross-sectional area, and uterine volume between PP and PT groups were 1.12 (0.78-1.45; p < 0.01), 0.90 (0.07-1.73; p = 0.03), 1.38 (0.99-1.78; p < 0.01), 1.06 (0.61-1.50; p < 0.01), and 1.21 (0.84-1.58; p <0.01), respectively. A uterine length of 3.20 cm yielded a pooled sensitivity of 81.8% (95% CI 78.3%-84.9%), specificity of 82.0% (95% CI 61.0%-93.0%), PLR of 4.56 (95% CI 2.15-9.69), NLR of 0.26 (95% CI 0.17-0.39), and DOR of 19.62 (95% CI 6.45-59.68). The area under the summary receiver operating characteristics curve was 0.82.
CONCLUSION
Female pelvic ultrasonography may serve as a complementary tool to the GnRH stimulation test in differentiating PP from PT.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232427, ID: CRD42021232427.
Topics: Child; Diagnosis, Differential; Female; Humans; Puberty, Precocious; Sensitivity and Specificity; Ultrasonography; Uterus
PubMed: 34539579
DOI: 10.3389/fendo.2021.735875 -
Frontiers in Endocrinology 2017We describe the etiology, MRI findings, and growth patterns in girls who had presented with signs of precocious puberty (PP), i.e., premature breast development or early...
INTRODUCTION
We describe the etiology, MRI findings, and growth patterns in girls who had presented with signs of precocious puberty (PP), i.e., premature breast development or early menarche. Special attention was paid to the diagnostic findings in 6- to 8-year-olds.
MATERIALS AND METHODS
We reviewed the medical records of 149 girls (aged 0.7-10.3 years) who had been evaluated for PP in the Helsinki University Hospital between 2001 and 2014.
RESULTS
In 6- to 8-year-old girls, PP was most frequently caused by idiopathic gonadotropin-releasing hormone (GnRH)-dependent PP (60%) and premature thelarche (PT; 39%). The former subgroup grew faster (8.7 ± 2.0 cm/year, = 58) than the girls with PT (7.0 ± 1.1 cm/year, = 32) ( < 0.001), and the best discrimination for GnRH-dependent PP was achieved with a growth velocity cut-off value of 7.0 cm/year (sensitivity 92% and specificity 58%) [area under the curve 0.82, 95% confidence interval (CI) 0.73-0.91, < 0.001]. Among asymptomatic and previously healthy 6- to 8-year-old girls with GnRH-dependent PP, one (1.7%, 95% CI 0.3-9.7%) had a pathological brain MRI finding requiring surgical intervention (craniopharyngioma). In girls younger than 3 years, the most frequent cause of breast development was PT, and, in 3- to 6-year-olds, GnRH-dependent PP.
CONCLUSION
In 6- to 8-year-old girls, analysis of growth velocity is helpful in differentiating between PT and GnRH-dependent PP. Although the frequency of clinically relevant intracranial findings in previously healthy, asymptomatic 6- to 8-year-old girls was low, they can present without any signs or symptoms, which favors routine MRI imaging also in this age group.
PubMed: 28878739
DOI: 10.3389/fendo.2017.00213