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Archives of Disease in Childhood Dec 1980Hypothalamic-pituitary-gonadotropic activity was investigated in 9 girls with premature thelarche, and compared with that in 9 healthy girls and 6 girls with true...
Hypothalamic-pituitary-gonadotropic activity was investigated in 9 girls with premature thelarche, and compared with that in 9 healthy girls and 6 girls with true precocious puberty. The gonadotropin stimulation test with luteinising hormone-releasing hormone was used. Girls with premature thelarche showed luteinising hormone response resembling that of normal girls, and follicle-stimulating hormone (FSH) response quite similar to that of girls with precocious puberty. This suggests that in premature thelarche there is a partial activation of the diencephalic-hypophyseal-gonadal axis, which affects FSH only. Premature thelarche therefore, should be considered as one of the disorders due to altered sensitivity of the hypothalamic receptors which regulate sex maturation.
Topics: Breast; Child; Child, Preschool; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Hypothalamo-Hypophyseal System; Infant; Luteinizing Hormone; Puberty, Precocious
PubMed: 6779715
DOI: 10.1136/adc.55.12.941 -
Hormone Research in Paediatrics 2021The aim of this study is to determine the cutoff values of gonadotropin response to gonadotropin-releasing hormone analogs (GnRHas) corresponding to the activation of...
Assessment of Gonadotropin Concentrations Stimulated by Gonadotropin-Releasing Hormone Analog by Electrochemiluminescence in Girls with Precocious Puberty and Premature Thelarche.
OBJECTIVE
The aim of this study is to determine the cutoff values of gonadotropin response to gonadotropin-releasing hormone analogs (GnRHas) corresponding to the activation of the hypothalamic-pituitary-gonadal axis that could differentiate central precocious puberty (CPP) from premature thelarche (PT) and using the electrochemiluminescence assay method.
METHODS
A total of 49 girls underwent the stimulation test with an intramuscular injection of 3.75 mg leuprolide acetate. Based on the clinical and laboratory characteristics, they were divided into two groups: CPP (n = 22) and PT (n = 27). Baseline estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were collected before GnRHa administration and LH and FSH at 60 and 120 min, respectively, after GnRHa administration.
RESULTS
The girls with CPP presented an increased height Z-score, advanced bone age, and higher baseline LH, FSH, estradiol, and LH/FSH ratio in relation to PT (p < 0.001). Stimulated LH differed significantly between the two groups, and the LH cutoff values were ≥4.29 IU/L (p < 0.001) and ≥3.95 IU/L at 60 and 120 min, respectively (p < 0.001). The LH peak was found at 60 min after stimulation.
CONCLUSIONS
The GnRHa test is effective in distinguishing CPP from PT, and a single sampling, at 60 min, with LH concentrations above 4.29 may be the parameter of choice with the advantage of greater convenience and practicality.
Topics: Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins; Humans; Luteinizing Hormone; Puberty, Precocious
PubMed: 34933304
DOI: 10.1159/000521593 -
The Journal of Pediatrics Jan 1995To evaluate whether girls with premature thelarche progress to central precocious puberty (CPP) and to analyze their clinical and hormonal characteristics, we...
To evaluate whether girls with premature thelarche progress to central precocious puberty (CPP) and to analyze their clinical and hormonal characteristics, we retrospectively examined 100 girls with premature thelarche who were followed for several years. Fourteen of the patients with characteristics diagnostic of premature thelarche (isolated breast development before age 8 years, bone age advancement within 2 SD of normal, normal growth velocity, follicle-stimulating hormone-predominant response to luteinizing hormone-releasing hormone) progressed during follow-up to precocious or early central puberty (progressive breast size increase, bone age acceleration, and significant decrease in predicted adult height). The chronologic age of this group of 14 girls was 5.1 +/- 2.0 years at the onset of premature thelarche and 7.8 +/- 0.6 years (mean +/- SD) after progression to central early or precocious puberty. Pelvic ultrasonography showed significant differences in measurements between the time of diagnosis of premature thelarche and progression to CPP. Nine of these patients required treatment, three with cyproterone acetate and six with luteinizing hormone-releasing hormone analogs, and all responded as expected for classic CPP. At baseline evaluation, no clinical or hormonal characteristics could be established that separated the 14 children who progressed to precocious or early puberty from the 86 girls who did not. We conclude that premature thelarche is not always a self-limited condition and may sometimes accelerate the timing of puberty.
Topics: Age Determination by Skeleton; Age of Onset; Bone Development; Breast; Child; Child, Preschool; Cyproterone Acetate; Estrogens; Female; Gonadotropin-Releasing Hormone; Growth; Humans; Puberty, Precocious; Retrospective Studies
PubMed: 7815198
DOI: 10.1016/s0022-3476(95)70492-2 -
Endocrinology and Metabolism Clinics of... Mar 1991Current concepts of normal and pathologic puberty have been reviewed. The key event in normal puberty is the commencement of pulsatile secretion of GnRH during sleep,... (Review)
Review
Current concepts of normal and pathologic puberty have been reviewed. The key event in normal puberty is the commencement of pulsatile secretion of GnRH during sleep, which leads to augmentation of LH levels with the onset of sleep. Schemata are presented for the initial evaluation of patients with primary amenorrhea and secondary amenorrhea based on whether they are hypoestrogenic or estrogenized. Menstrual abnormalities are also discussed from a diagnosis-based perspective. The role of the bone age in differential diagnosis of pubertal disorders is emphasized. The variable presentations of Turner syndrome, hyperprolactinemia, and PCOS are reviewed. Current understanding of the role of undernutrition and stress in anorexia nervosa, psychogenic amenorrhea, and athletic amenorrhea is presented, and management guidelines are reviewed. The evidence that premature pubarche is usually due to premature adrenarche is discussed. The concept that premature thelarche lies on a spectrum between normal and early puberty is discussed. The reader is also reminded that many girls with idiopathic true sexual precocity do not require treatment to preserve height potential.
Topics: Adolescent; Female; Hormones; Humans; Menarche; Menstruation Disturbances; Puberty; Puberty, Delayed; Puberty, Precocious; Reproduction
PubMed: 2029884
DOI: No ID Found -
International Journal of Molecular... May 2020Several pesticides are recognized as endocrine-disrupting chemicals (EDCs) since they can interfere with the dysregulation of sexual, thyroid and neuro-endocrine...
Several pesticides are recognized as endocrine-disrupting chemicals (EDCs) since they can interfere with the dysregulation of sexual, thyroid and neuro-endocrine hormones. Children are particularly vulnerable to the adverse effects of EDCs due to their developmental stage, peculiar lifestyle and dietary habits. In this context, the exposure to pesticides represents an important risk factor associated with early development. This study deals with the possible association between exposure to pesticides and idiopathic premature thelarche in girls from areas of intensive agriculture practice in the Centre of Italy. An integrated approach was set up, including: (i) a case-control study on girls with idiopathic premature thelarche; (ii) the evaluation of multiple pesticides exposure in girls; (iii) the evaluation of multiple pesticides in food; (iv) the dietary intake of pesticide residues; (v) the assessment of toxicological effects of widely used pesticides by in vitro model. Data integration will provide an estimate of the predictive risk of potential effects on girls' health, linked to dietary intake.
Topics: Child; Dietary Exposure; Endocrine Disruptors; Female; Humans; Pesticides; Puberty, Precocious
PubMed: 32384657
DOI: 10.3390/ijms21093282 -
Best Practice & Research. Clinical... Feb 2003Puberty is the period of life during which reproductive capability is acquired. It is characterized clinically by the acquisition of secondary sexual characteristics... (Review)
Review
Puberty is the period of life during which reproductive capability is acquired. It is characterized clinically by the acquisition of secondary sexual characteristics associated with a growth spurt, and on average takes 3-4 years. Early maturation is defined as the development of sexual characteristics before the age of 8 years in girls and 9 years in boys. Delayed puberty is defined when there are no signs of puberty at the age of 13.4 years in girls and 14 years in boys (2 SD above the mean of chronological age for the onset of puberty). There are many forms of premature sexual maturation: gonadotrophin-dependent (central, or 'idiopathic' or 'true' precocious puberty) and gonadotrophin-independent precocious puberty (McCune-Albright syndrome in girls, testotoxicosis in boys); isolated premature thelarche (in the forms of classical, atypical and variant); premature adrenarche (characterized by the production of significant quantities of androgens between 5 and 8 years of age); premature menarche. The differential diagnosis of delayed puberty is between constitutional delay of growth and puberty, pubertal delay secondary to chronic disease and hypogonadotrophic hypogonadism.
Topics: Adolescent; Algorithms; Child; Chronic Disease; Diagnosis, Differential; Female; Gonadotropins; Growth Disorders; Humans; Hypogonadism; Male; Puberty; Puberty, Delayed; Puberty, Precocious
PubMed: 12758225
DOI: 10.1053/ybeog.2003.0360 -
AJR. American Journal of Roentgenology Mar 2015OBJECTIVE. We analyzed the correlation between breast development and ultrasound-measured breast bud diameter. We also evaluated different breast ultrasound findings in... (Comparative Study)
Comparative Study
OBJECTIVE. We analyzed the correlation between breast development and ultrasound-measured breast bud diameter. We also evaluated different breast ultrasound findings in pediatric subjects with precocious puberty and premature thelarche while comparing bone age and hormone levels. MATERIALS AND METHODS. We performed a retrospective study with a sample of 90 girls (mean age, 7.8 years) who underwent breast ultrasound for evaluation of early breast development between March 2011 and February 2013. We evaluated breast ultrasound grade, bud diameter, and clinical characteristics including bone age and hormone levels. Among the 90 girls, 69 were up to 8 years old (mean age, 7.3 years). We divided them into healthy, precocious puberty, and premature thelarche groups and evaluated the clinicoradiologic findings for each group. RESULTS. Breast ultrasound grade was correlated with age, bone age, bud diameter, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and estradiol (E2). Bud diameter was correlated with age, bone age, LH, FSH, and E2. However, the difference between bone age and chronological age was not correlated with ultrasound grade or bud diameter. Among 69 girls up to 8 years old, including 11 healthy girls (15.9%), 26 girls with precocious puberty (37.7%) (mean [SD] age, 7.3 years), and 32 girls with premature thelarche (46.4%) (mean age, 7.2 years), there were no significant differences in other variables except values for bone age (p = 0.001) and difference between bone age and chronological age (p < 0.001). CONCLUSION. Breast ultrasound might be useful for evaluating sexual development with respect to bud diameter or ultrasound grade. However, its ability to distinguish precocious puberty from premature thelarche is limited.
Topics: Age Determination by Skeleton; Breast; Child; Child, Preschool; Diagnosis, Differential; Estradiol; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Puberty, Precocious; Retrospective Studies; Ultrasonography, Mammary
PubMed: 25714294
DOI: 10.2214/AJR.14.12565 -
American Journal of Diseases of... Dec 1986Pediatric endocrinologists in Puerto Rico reported a threefold increase in the number of patients with premature thelarche seen between 1978 and 1981. A matched-pairs...
Pediatric endocrinologists in Puerto Rico reported a threefold increase in the number of patients with premature thelarche seen between 1978 and 1981. A matched-pairs case-control study was conducted to evaluate associations with potential environmental exposures to substances with estrogenic activity, as well as with familial factors. Analysis was performed on 120 pairs, the case subjects of which were selected from those diagnosed between 1978 and 1982. In subjects 2 years of age or older at the onset of thelarche, no significant associations were found. In subjects with onset before 2 years of age, significant positive associations were found with a maternal history of ovarian cysts, consumption of soy-based formula, and consumption of various meat products. A statistically significant negative association was found with consumption of corn products. These statistical associations are probably not sufficient to explain the reported increase because in over 50% of the case subjects there was no exposure to any of the risk factors for which statistical associations were found. Exposure to other substances with possible estrogenic effect, such as waste products from pharmaceutical factories and pesticides, was also excluded as a possible cause. These findings suggest that better diagnosis and reporting, or conceivably the presence of entirely new, unsuspected factors, could account for the reported increase.
Topics: Animals; Breast; Chickens; Child; Child, Preschool; Environmental Exposure; Female; Food Additives; Humans; Infant; Infant Food; Meat Products; Puberty, Precocious; Puerto Rico
PubMed: 3776944
DOI: 10.1001/archpedi.1986.02140260065028 -
Acta Paediatrica (Oslo, Norway : 1992) Feb 2012To assess the prevalence of premature thelarche (PT) and pubarche in healthy 4- to 8-year-old girls and to investigate factors associated with early pubertal development.
AIM
To assess the prevalence of premature thelarche (PT) and pubarche in healthy 4- to 8-year-old girls and to investigate factors associated with early pubertal development.
METHOD
Eight hundred and twenty girls were examined by two paediatric endocrinologists to determine Tanner staging. The effects of body mass index, gestational age, intrauterine growth status, age at the first tooth eruption, socio-economical status, maternal age of menarche and consumption of certain food items on early pubertal development were analysed through parametric and nonparametric tests.
RESULTS
The prevalence of PT and of premature pubarche was 8.9% and 4.3%, respectively. We found a strong association between the prevalence of PT and the body mass index standard deviation scores (BMI SDS). There were more girls with BMI SDS values above 1 in the PT group (56.1%) than among the remaining subjects (22.9%). Premature thelarche was not significantly associated with intrauterine growth, premature birth, socioeconomic status, age of first tooth eruption or maternal age of menarche. Similarly, the amount of milk, eggs, chicken or fish consumed was not associated with PT. None of the investigated factors were associated with premature pubarche.
CONCLUSION
Occurrence of PT is strongly associated with BMI SDS. Studies investigating secular trends in pubertal development must consider a secular change in body mass index.
Topics: Body Mass Index; Breast; Child; Child, Preschool; Female; Humans; Prevalence; Puberty, Precocious; Risk Factors
PubMed: 21854448
DOI: 10.1111/j.1651-2227.2011.02444.x -
The Journal of Clinical Endocrinology... Jul 2020
Topics: Breast; Endocrine Disruptors; Gynecomastia; Humans; Lavandula; Male; Puberty, Precocious
PubMed: 32379885
DOI: 10.1210/clinem/dgaa226