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Abstract Introduction Prior studies have found inconsistent results regarding the relationship between vitamin D status and Idiopathic Central Precocious Puberty (ICPP). Objective To assess the role of serum 25-hydroxyvitamin D (25 [OH]D) levels in ICPP development. Method The authors retrospectively collected data from 221 girls with ICPP and 144 healthy girls between January 2017 and December 2019. The participants' serum 25(OH)D levels were measured using an automatic chemiluminescence method, and the association between serum 25(OH)D levels and the risk of ICPP was assessed using multivariate logistic regression analysis. Odds Ratios (OR) with 95% Confidence Intervals (95% CI) were calculated as effect estimates. Results Serum 25(OH)D levels in the ICPP group were significantly lower than those in healthy controls (p < 0.001). Multivariate analysis indicated that girls with insufficient vitamin D levels (OR = 0.201; 95% CI 0.094-0.428; p < 0.001) and sufficient vitamin D levels (OR = 0.141; 95% CI 0.053-0.375; p < 0.001) both had a lower risk of ICPP than girls with vitamin D deficiency. Moreover, the authors found that the height (p = 0.014), weight (p = 0.014), breast stage (p = 0.010), mother's height (p < 0.001), and luteinizing hormone/follicle-stimulating hormone ratio (p = 0.010) in girls with ICPP could be associated with levels of vitamin D. Conclusion This study found that a low serum 25(OH)D level is an independent risk factor for ICPP, and several characteristics of girls with ICPP could be affected by their vitamin D status.
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Objective@#To investigate glucolipid metabolism and sex hormone levels among female children with precocious puberty, so as to provide insights into the illustration of pathogenesis of precocious puberty. @*Methods@#A total of 110 female children with precocious puberty treated in Huzhou Maternity & Child Health Care Hospital during the period from May 2019 through May 2021 were enrolled and assigned into the idiopathic central precocious puberty (ICPP) group and the premature thelarche alone (PT) group according to the results of gonadotropin-releasing hormone stimulation tests. The follicle stimulating hormone (FSH), luteinizing hormone (LH), progesterone (P), estradiol (E2), testosterone (T), prolactin (PRL), fasting insulin (FINS), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB) andlipoprotein-a [Lp (a)] levels were detected and compared in children between the ICPP and PT groups.@*Results@#There were 70 cases in the ICCP group, with a mean age of (7.62±1.13) years and a mean body mass index (BMI) of (16.30±2.21) kg/m2 and 40 cases in the PT group, with a mean age of (7.42±1.04) years and a mean BMI of (16.70±2.10) kg/m2 (both P>0.05). The FSH [(3.58±0.80) vs. (2.22±0.75) IU/L], LH [(1.40±0.28) vs. (0.25±0.12) IU/L], P [(0.29±0.12) vs. (0.18±0.08) ng/mL], E2 [(23.28±4.23) vs. (15.54±2.75) pg/mL] and PRL [(8.56±1.93) vs. (6.54±1.50) ng/mL], FINS [(13.24±2.54) vs. (11.10±2.49) U/L], TG [(1.36±0.17) vs. (1.21±0.27) mmol/L], LDL-C [(3.10±0.44) vs. (2.81±0.60) mmol/L], ApoB [(0.78±0.19) vs. (0.71±0.14) g/L] and Lp (a) levels [(252.45±52.10) vs. (202.60±41.28) mg/L] were significantly higher in the ICPP group than in the PT group (all P<0.05).@*Conclusion@#The levels of sex hormones and glucolipid metabolism parameters are significantly higher among female children with ICPP than among those with PT.
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Objective: To study the therapeutic effect of triptorelin acetate combined with psychological intervention on the chil-dren with idiopathic central precocious puberty. Methods: Totally 40 cases of central precocious puberty were randomly divided into the observation group and the control group with 20 ones in each. The control group was injected with triptorelin acetate, once every 28 d; the observation group was given psychological intervention on the basis of the control group, once every 28 d. The emotional stabili-ty, depressive psychology, treatment compliance, height, body weight, growth rate, bone age ( BA) and adult height ( PAH) of the two groups before and after one-year treatment were observed and compared. Results: After the one-year treatment, the scores of emo-tional stability and depressive psychological HAMD in the observation group were significantly lower than those in the control group (P<0. 05), and the medication compliance was significantly higher in the observation group than that in the control group (P<0. 05). The growth rate and adult height of the children in the observation group were significantly higher than those in the control group (P<0. 05). Conclusion: Triptorelin acetate combined with psychological intervention in the treatment of children with idiopathic central precocious puberty can relieve depression, stabilize mood and improve medication compliance, and also effectively improve the growth rate and adult prediction height of the children.
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The relationship between vitamin D deficiency and idiopathic central precocious puberty (ICPP) has been recently documented. In this study, 280 girls diagnosed with ICPP and 188 normal puberty control girls of similar ages were enrolled and retrospectively studied. The ICPP group had significantly lower serum 25-hydroxyvitamin D (25[OH]D) levels than the control group. Furthermore, a nonlinear relationship was found between serum 25[OH]D and ICPP, and a cut-off point for serum 25[OH]D was found at 31.8 ng/ml for ICPP with and without adjusting the different confounding factors. Girls with serum 25[OH]D ≥ 31.8 ng/ml had a lower odds ratio (unadjusted: OR 0.36, 95% CI 0.15 to 0.83, P < 0.05; height and weight adjusted: OR 0.44, 95% CI 0.18 to 1.08, P = 0.072; BMI adjusted: OR 0.36, 95% CI 0.16 to 0.84, P < 0.05). The ICPP subjects with 25[OH]D deficiency had a higher body mass index (BMI) than the subjects from the two other subgroups. Correlation analysis showed that vitamin D level is correlated with BMI and some metabolic parameters in the ICPP group. Our study suggested that vitamin D status may be associated with ICPP risk and may have a threshold effect on ICPP.
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Child , Female , Humans , Body Mass Index , China , Linear Models , Logistic Models , Multivariate Analysis , Puberty, Precocious , Blood , Retrospective Studies , Vitamin D , Blood , Vitamin D Deficiency , EpidemiologyABSTRACT
The effect of obesity on idiopathic central precocious puberty (ICPP) girls is still under discussion.The relationship between body mass index (BMI) and sexual hormone levels of gonadotropin-releasing hormone (GnRH) stimulation test in ICPP girls is controversial and the underlying mechanism is unclear.This study aims to further explore the independent effect of excess adiposity on peak luteinizing hormone (LH) level of stimulation test in ICPP girls and the role of other related factors.A retrospective cross-sectional study was performed on 618 girls diagnosed as having ICPP,including 355 cases of normal weight,99 cases of overweight and 164 cases of obese.The results showed that obese group had more progressed Tanner stage and no significant difference (P=0.28) in LH peak was found as basal LH value was used as a covariate.The obese group had higher total testosterone (TT),adrenocorticotrophic hormone (ACTH),17-α hydroxyprogesterone (17-αOHP) and androstendione (AN),with significantly increased fasting insulin (FIN) and homeostasis model of assessment for insulin resistance index (HOMA-IR).Stratified analysis showed inconsistency of the relationship between BMI-standard deviation score (BMI-SDS) and LH peak in different Tanner stages (P for interaction=0.017).Further smoothing plot showed linear and non-linear relationship between BMI-SDS and LH peak in three Tanner stages.Then linear regression model was used to analyze the relationship between BMI-SDS and LH peak in different Tanner stages,with and without different confounding factors being adjusted.In B2 stage,BMI-SDS was negatively associated with LH peak.In B3 stage,when BMI-SDS ＜1.5,as BMI-SDS increased,the level of LH peak decreased (model Ⅰ:β=-1.8,95％ CI=-4.7 to 1.1,P=0.214).When BMI-SDS ≥1.5,BMI-SDS was significantly positively associated with LH peak (model Ⅰ:β=4.5,95％ CI=1.7 to 7.4,P=0.002).In B4 stage,when BMI-SDS ＜1.5,BMI-SDS was negatively associated with LH peak (model Ⅰ:β=-11.6,95％ CI=-22.7 to-4.5,P=0.049).When BMI-SDS ≥1.5,BMI-SDS was positively associated with LH peak (model Ⅰ:β=-4.2,95％ CI=-3.3 to 11.7,P=0.28).It is concluded that there is an independent correlation between BMI-SDS and LH peak of stimulation test in ICPP girls,their relationships are different in different Tanner stages,and the effect of BMI-SDS can be affected by adrenal androgens,estradiol and glucose metabolism parameters.
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Objective To investigate the characteristics of quality of life (QoL) and self-awareness in girls with idiopathic central precocious puberty (ICPP) and the correlation between QoL and the self-awareness.Methods The inventory of subjective life quality (ISLQ) and Children's self-concept scale (PHCSS) were employed to evaluate the level of QoL and self-awareness in 24 ICPP girls with ICPP (ICPP group) and 24 normal control girls (control group),and the correlation analysis between QoL and the self-awareness in the ICPP group was made.Results The score of overall (70.85±14.11 vs 80.21±6.07) and emotion component satisfaction (62.61± 12.91 vs 73.74±5.02),dimensions satisfaction on school life (5.80± 1.44 vs 6.69±0.65),depression experience (6.55± 1.14 vs 7.29±0.45),anxiety experience (5.93± 1.35 vs 6.96±0.82) and physical emotion (6.33±1.17 vs 7.12±0.83) in ICPP group was respectively lower than control group (P＜0.05).There was no difference in cognitive component between control group and ICPP group,as well as for other dimension satisfaction.Moreover,the score in total self-awareness,physical appearance and anxiety in ICPP group was respectively lower than those in control group (P＜0.05).In addition,a positive correlation was found between the subjective QoL and the children self-concept in ICPP group (P＜0.01).Conclusion The girls with ICPP show a lower subjective QoL and self assessment than normal girls.It is important to take care of the psychological feature of the girls with ICPP to improve the self-assessment and overall QoL during the medication.
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Objective To explore the significance and value of Kisspeptin in the diagnosis and therapeutic evaluation for idiopathic central precocious puberty(ICPP) in girls.Methods Twenty-four girls with ICPP and 21 girls with premature thelarche(PT) who were hospitalized in the Children's Hospital of Jiangxi Province from Jun.2012 to Jan.2013 were selected as ICPP group and PT group,and 25 healthy girls were selected as healthy control group.The coagulation vein blood in ICPP girls before treatment and after 6 months treatment and PT girls and healthy girls were collected,and enzyme linked immunosorbent assay was used to detect the plasma Kisspeptin level,and t test was used to analyze the differences among the 4 groups.Results The Kisspeptin level of girls with ICPP [(1.80 ± 0.13) μg/L]was apparently higher than that of PT groups [(1.41 ± 0.10) μg/L] and healthy control group[(1.39 ± 0.13) μg/L],and the differences were statistically significant (t =10.974,14.787,all P =0.000).However,the difference of Kisspeptin between PT group and healthy control group was not statistically significant(t =10.970,P =0.095).In addition,the Kisspeptin level of ICPP girls who undewent 6-month treatment [(1.49 ± 0.15) μg/L] was significantly lower than that before treatment,and the difference was statistically significant (t =10.80,P ＜ 0.05) ;but,compared with PT group and healthy control group,there was no significant difference (t =6.32,P =0.060 ; t =7.44,P =0.214).Conclusions Kisspeptin level is related with pubertal development,and it can be used as an important evidence in ICPP diagnosis and an important parameter in ICPP therapeutic evaluation.
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Objective The report was focused on polycystic ovary syndrome(PCOS) in female adolescents related to homosexual precocious puberty,and the new awareness of its influence on long-term health of homosexual precocious girls.Methods A girl with idiopathic central precocious puberty (ICPP) but diagnosed as PCOS in adolescence was reported and the data were reviewed.Results A girl was diagnosed as ICPP when she was near 8 years old with obesity,but without hyperinsulinemia,then she received the treatment of a 3.75 mg dose gonadotropin hormone analogues (GnRHa) every 28 days.Her gonads development was under control while her growth was arrested.Growth hormone(GH) injection started at 13 months.She stopped all medications when finished GH and GnRHa treatment for 12 months and 25 months.She went to see doctors again because of no menarche after discontinuing medication for nearly 2 years.She appeared obese and acne,hirsutism,athanens negricans and purple purple striae on the skin.Hyperinsulinemia and hypertestosterone were demonstrated.Pelvic B ultrasonography showed polycystic ovary,and she was diagnosed as PCOS.She was ordered to lose weight and to take metformin.And adrenocorticotropic hormone stimulating test was done,and B ultrasonography again ruled out atypical congenital adrenal hyperplasia and tumor of adrenal gland.She got her menarche 1 month later.Twelve months after the PCOS diagnosis and treatment,she had 4 menses,her insulin level decreased,glucose tolerance and her serum testosterone level turned normal.At the same time,the form of ovarian and follicular was significantly reduced.After taking mefformin for 20 months,her height and weight did not change,her menstrual was regular every 35-40 days,each time lasting about 7 days.She was followed up.We also reviewed literatures and learnt that precocious puberty might not be a benign situation and it might have an intrinsic relation to obesity,precocious puberty and PCOS.It might be the cofactors for causing PP and PCOS that accessed luteinizing hormone(LH) secretion and disorder of hypothalamus pituitary gonad(HPG) axis except obesity with hyperinsulinemia.Reported pubertas praecox in childhood developed to PCOS at 30％ with high prevalence of obesity.GnRHa suppressive therapy might relate to PCOS and had disputation for improving final height.There were fewer investigations on adolescent PCOS,and no consensus guideline on it in China.Conclusions Girls with ICPP may develop to PCOS some time later.The clinical features of the reported girl and the knowledge from literatures support the hypothesis that inner relationship between the CPP and the PCOS.The LH high secretion and disorder of HPG axis may be the causes of them; LH treatment on suppressing obesity should be cautious during treatment.The benefit and risk from GnRHa treatment should be evaluated thoroughly.Further clinical research should be conducted on adolescent PCOS.
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Objective To observe the gonadotropin analogue ( GnRHa) Triptorelin of idiopathic central pre-cocious puberty(ICPP) girls′body mass index(BMI) and final adult height(FAH).Methods 120 patients with idi-opathic central precocious puberty cases were summarized and track the return visit ,which.of 62 cases with ICPP girls Triptorelin treatment,6,12,18,24,36 months of observation and treatment of bone age (BA),the growth rate(GV), BMI,predicted height ( PAH) ,and life-long high and up to lifelong high BMI .The untreated group was also observed the relevant indicators such as BMI ,and lifelong.Results After treatment,the increase in BA was less than that in age.The PAH has improved with the growth of the treatment regimens .After treatment PAH 12,18,24,36 months PAH respectively[(153.4 ±7.1)cm,(154.6 ±6.2)cm,(155.7 ±4.7)cm,(156.9 ±5.9) cm], both were statisti-cally significant(t=2.23,2.67,3.01,2.88,all P0.05).Lifelong treatment and control groups,respectively[(158.2 ±3.9)cm,(153.7 ±2.8) cm],and between the two there is a statistically significant (t=3.04,P0.05). Conclusion Triptorelin can effectively suppress idiopathic central precocious sexual characteristics and bone age growth and improve adult height .There is no significant effect on the BMI .
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Objective To assess the effects of gonadotropin-releasing hormone analog on glucose and lipid metabolism in girls with idiopathic central precocious puberty(ICPP).Methods A total of 26 girls (aged 6-8 years,breast stage B2) with ICPP were followed up in Department of Endocrinology,Shenzhen Children's Hospital from Jan.2008 to Jun.2011.Those girls received triptorelin therapy for 12 months.Before and the end of the 6th month,the 12th month of the treatment,body mass index(BMI) was calculated,fasting plasma glucose(FPG),fasting plasma insulin(FPI),total cholesterol,triacylglycerols,high density lipoprotein cholesterol,low density lipoprotein cholesterol,apolipoprotein A,apolipoprotein B and estradiol(E2) were measured.Insulin sensitivity was estimated by homeostasis model assessment of insulin resistance(HOMA-IR).Twenty age-matched prepuberty girls were set as controls.Results 1.Before treatment,BMI,FPG,FPI and HOMA-IR in ICPP girls had no significant difference compared with the controls.2.After 6 months treatment of triptrolin,serum E2 concentration in ICPP girls declined from(30.5 ± 9.8) ng/L at the beginning of treatment to (11.2 ± 4.6) ng/L at the end of 6th month (P ＜ 0.01) ; The end of 12 th month of the treatment,FPG and FPI had no significant difference compared with that before of the treatment,but BMI increased from(16.46 ± 1.10) kg/m2 to(18.35 ± 1.30) kg/m2,the difference was significant(P ＜0.05),HOMA-IR increased from 1.24 ±0.30 to 2.08 ±0.40,the difference was significant(P ＜0.05).3.Lipid metabolism parameters remained unchangeable after 12 months of triptrolin treatment.Conclusion Triptorelin may lead to raise of BMI and HOMA-IR in girls with ICPP at 12 months after treatment.
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Objective To investigate the pattern of plasma kisspeptin levels in normal female during various pubertal Tanner stages and the girls with idiopathic central precocious puberty(ICPP) or with premature thelarche(PT), and to evaluate the significance of detecting plasma kisspeptin levels as a new criterion for early differentiation between ICPP and PT.Methods Each study group of normal pubertal females with Tanner stage Ⅰ to Ⅴ comprised 16 to 19 individuals.The levels of plasma kisspeptin were also detected in girls with ICPP(n= 10)or PT(n = 12).The plasma kisspeptin levels were detected by enzyme-linked immunosorbent assay (ELISA).Results The level of kisspeptin was significantly higher in ICPP group than in that of PT group [(1.73±0.23 vs1.43±0.29) ng/ml, P＜0.05].Among the normal pubertal females, the level of kisspeptin decreased gradually from Tanner stage Ⅱ to Tanner stage Ⅴ, being highest in Tanner stage Ⅱ [(1.73±0.22) ag/ml] ,lower in stage Ⅳ and Ⅴ than in stage Ⅰ and Ⅲ (P＜0.01).Conclusions Plasma kisspeptin level was the highest during Tanner stage Ⅱ in normal female pubertal development.It is significant to detect plasma kisspeptin level for the differential diagnosis of ICPP and PT.
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Objective To explore the relationship between adrenarche and gonadarche.Methods Total 49 idiopathic central precocious puberty(ICPP)girls,whose serum dehydroepiandrosterone sulfate(DHEAS)Z scores for chronological age were higher than+2 s at diagnosis.were enrolled.Physical examinations during pubertal stage were repeated at 3-6 months intervals,and serum DHEAS levels were monitored yearly within an average period of 4.08 years.Of them,16 girls were followed up until more than one year after discontinuation of gonadotropin-releasing hormone analogue(GnRHa)treatment.Results Before GnRHa treatment,these49 girls presented a younger average age at attainment of pubic hair stage2(PH2)and pubic hair stage3(PH3)than normal(8.07 years vs 11.16 years,8.82 years vs 12.40 years respectively).During GnRHa treatment,the intervals between PH2 and PH3,PH3 and pubic hair stage4(PH4),breast stage 2(B2),and PH2 were longer than normal(1.69 years vs 0.83 years,1.64 years vs 0.60 years,and3.62 years vs 0.76 years respectively).The intervals between PH2 and PH3,as well as B2 and PH2 during GnRHa treatment were also longer than that before GnRHa treatment(1.69 years/35 0.88 years,3.62 years vs 1.13 years respectively).The serum DHEAS Z scores decreased during GnRHa treatment,and increased significantly after GnRHa cessation.Conclusion Gonadarche after age of 6-year-old may lead to earlier adrenarehe.GnRHa treatment might slow down the progression of adrenarche and suppress the hypothalamuspituitary-gonadal axis.
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Objective To observe the clinical effect of gonadotropin releasing hormone analogues in treatment of the girls with idiopathic central precocious puberty(ICPP). Methods Twelve girls with ICPP received therapy with GnRH-A.Before and after the end of treatment for 6 months,secondary sexual characteristics and growth velocity were observed,pelvic ultrasonic examination,X-ray bone age(BA),serum level of E_2 and LHRH stimulating test were detected,and the predicted adult height(PAH) was analysed. Results After treatment,the size of breasts,uterus and ovaries were significantly reduced.The basic and peak levels of serum LH and FSH by LHRH stimulation were also significantly reduced.The ratio of BA/CA(chronology age)was decreased.The PAH was increased. Conclusions GnRH-A can effectively depress the sexual characteristics,reduce the maturation of BA,and also improve the PAH in girls with ICPP.