ABSTRACT
La hipertricosis cubital es un aumento localizado de la densidad, longitud y espesor del vello. Es una entidad benigna con muy escasos pacientes descritos en la literatura médica (alrededor de medio centenar). La mitad de los casos descritos asocian otros defectos o malformaciones, y la otra mitad son problemas puramente estéticos. La pubarquia precoz en niñas se define como el inicio del vello púbico antes de los 8 años de edad. Se presenta a una paciente de 6 años con la asociación no descrita previamente de hipertricosis cubital y pubarquia precoz.
Hypertrichosis cubiti is a localized increase in hair density, length and thickness. It is an uncommon and benign entity with very few patients described in the medical literature (more or less than half a hundred). Half of the described patients associate other defects or malformations and the other half are purely aesthetic cases. Early pubarche in girls is defined as the onset of pubic hair before 8 years of age. We present a six-year-old patient with the association not previously described of hypertrichosis cubiti and precocious pubarche.
Subject(s)
Humans , Female , Child , Puberty, Precocious/diagnosis , Growth Disorders/diagnosis , Hypertrichosis/congenital , Puberty, Precocious/pathology , Growth Disorders/pathology , Hypertrichosis/diagnosis , Hypertrichosis/pathologyABSTRACT
El autor de este artículo repasa las características clínicas de la pubertad precoz y la pubertad temprana, las pruebas diagnósticas indicadas en la evaluación de los pacientes que la presentan y las recomendaciones actuales de tratamiento. (AU)
The author of this article reviews the clinical features of early puberty, the diagnostic tests for the patients Ì evaluation andthe current treatment recommendations. (AU)
Subject(s)
Humans , Male , Female , Child , Puberty, Precocious/therapy , Gonadotropin-Releasing Hormone/agonists , Puberty, Precocious/classification , Puberty, Precocious/pathology , Puberty, Precocious/blood , Puberty, Precocious/diagnostic imaging , Gonadotropin-Releasing Hormone/therapeutic use , Sex CharacteristicsABSTRACT
Se ha observado que el inicio de la pubertad en las niñas se viene produciendo cada vez a edad más temprana, motivando la preocupación de los padres y la búsqueda de atención ante la posibilidad de pubertad precoz. A la actualidad, el diagnóstico de pubertad precoz central y pubertad normal de inicio temprano mantiene puntos de corte cronológicos establecidos hace más de un lustro; esto, a pesar de los cambios seculares descritos en diversas poblaciones del orbe. La importancia de diferenciar un evento fisiológico de uno patológico es la necesidad de adoptar una decisión oportuna de tratamiento con la finalidad de evitar compromiso de la talla final, alteraciones en la vida reproductiva y riesgo de enfermedades a futuro, como las enfermedades cardiovasculares y cáncer de mama en la vida adulta. Por lo tanto, los límites para el inicio de la pubertad, basados en normalidad bioestadística poblacional, no deberían traducirse únicamente en el establecimiento de límites de edad cronológica, debido al riesgo de diagnósticos erróneos. En el presente artículo hacemos una revisión de los acontecimientos relacionados a la pubertad en sus formas fisiológicas y patológicas en niñas, presentando los acuerdos y controversias descritos en la literatura científica...
The onset of puberty in girls has been occurring each time at a younger age, generating concern among parents and seeking healthcare for possible precocious puberty. Nowadays diagnosis of central precocious puberty (CPP) and early puberty onset have chronological cutoff points established over five years ago and despite secular changes described in various populations of the world. The importance of differentiating a physiological event from a pathogenic one is mainly because of the need of timely decision to begin treatment in order to prevent height compromise, reproductive system alterations and risk of future diseases like cardiovascular disease and breast cancer in adulthood. Limits for puberty onset based on biostatistics in normal population should not be applied only to establish limits of chronological age because the risk of a wrong diagnosis. In this article physiological and pathological events of puberty in girls will be reviewed; agreements and disputes described in scientific literature will be presented...
Subject(s)
Humans , Gonadal Steroid Hormones , Sexual Maturation , Puberty, Precocious/diagnosis , Puberty, Precocious/pathologyABSTRACT
OBJECTIVES: Idiopathic central precocious puberty and its postponement with a (gonadotropin-releasing hormone) GnRH agonist are complex conditions, the final effects of which on bone mass are difficult to define. We evaluated bone mass, body composition, and bone remodeling in two groups of girls with idiopathic central precocious puberty, namely one group that was assessed at diagnosis and a second group that was assessed three years after GnRH agonist treatment. METHODS: The precocious puberty diagnosis and precocious puberty treatment groups consisted of 12 girls matched for age and weight to corresponding control groups of 12 (CD) and 14 (CT) girls, respectively. Bone mineral density and body composition were assessed by dual X-ray absorptiometry. Lumbar spine bone mineral density was estimated after correction for bone age and the mathematical calculation of volumetric bone mineral density. CONEP: CAAE-0311.0.004.000-06. RESULTS: Lumbar spine bone mineral density was slightly increased in individuals diagnosed with precocious puberty compared with controls; however, after correction for bone age, this tendency disappeared (CD = -0.74 + 0.9 vs. precocious puberty diagnosis = -1.73 + 1.2). The bone mineral density values of girls in the precocious puberty treatment group did not differ from those observed in the CT group. CONCLUSION: There is an increase in bone mineral density in girls diagnosed with idiopathic central precocious puberty. Our data indicate that the increase in bone mineral density in girls with idiopathic central precocious puberty is insufficient to compensate for the marked advancement in bone age observed at diagnosis. GnRH agonist treatment seems to have no detrimental effect on bone mineral density.
Subject(s)
Adolescent , Child , Female , Humans , Young Adult , Body Composition/physiology , Bone Density/physiology , Gonadotropin-Releasing Hormone/agonists , Puberty, Precocious/drug therapy , Puberty, Precocious/pathology , Absorptiometry, Photon , Age Factors , Body Mass Index , Body Composition/drug effects , Bone Density/drug effects , Case-Control Studies , Reference Values , Statistics, Nonparametric , Treatment OutcomeABSTRACT
O conhecimento das mudanças que ocorrem no útero e ovários durante a puberdade é fundamental ao investigar alterações da pelve feminina em crianças e adolescentes. O exame ultrassonográfico nestas pacientes é rotineiramente realizado por via abdominal usando o líquido da bexiga como uma janela ultrassônica, embora possa ser algumas vezes realizado pela via vaginal em adolescentes sexualmente ativas. As principais indicações para ultrassonografia pélvica em crianças e adolescentes são a puberdade precoce ou atrasada, dor ou massas pélvicas, genitália ambígua, sangramento vaginal em crianças e amenorreia primária. Neste artigo relatamos a técnica do exame, além de descrever os achados mais freqüentes.
The knowledge of uterine and ovarian changes in the puberty is essential in the investigation changes in the female pelvis of children and teenagers. In these patients, pelvic ultrasonography is routinely performed with a full bladder to produce an acoustic window, although this examination may also be performed with endovaginal approach in sexually active teenagers. Main indications for pelvic ultrasonography in children and teenagers are either early or delayed puberty, pelvic pain or tumors, ambiguous genitalia, vaginal bleeding in children, and primary amenorrhea. In the present paper, the authors describe the scanning technique and the most frequent sonographic findings.
Subject(s)
Humans , Female , Child , Adolescent , Pelvic Pain/diagnosis , Ovary , Pelvis , Puberty, Precocious , Pelvis/abnormalities , Puberty, Precocious/pathology , Uterus , Ovary , Pelvis/anatomy & histology , Pelvis , Puberty, PrecociousABSTRACT
Background: Improvements in environmental conditions may result in an earlier onset of thelarche. However, its onset is not homogeneous among different population groups. Aim: To assess the relationship between nutritional status, ethnicity and age of thelarche. Material and methods: Cross-sectional study of girls in second through sixth grade, attending 165 schools located in Chile's Araucania region. Of these, 231 girls who presented thelarche (breast button) were selected. The girls' surnames were used to identify their ethncity: indigenous had three or four last names of Mapuche indigenous origin (n =113), while non-indigenous were those who only had Chilean-Spanish last names (n =118). Weight, height, waist circumference and skinfold thicknesses were measured and socio-economic background information was collected through a home interview. Results: The median age of thelarche was 10 years and 4 months, regardless of ethnic group. Multivariant models showed that an increase of one z score unit of body mass index (BMI) decreased the median age of thelarche by 5.6 months (CI: -7.24 to -3.90), controlling for the effect of different covariables. A decrease in one z score of height retards the median age of thelarche by 5.5 months (CI: 4.02 to 6.98). Ethnicity did not influence the age of thelarche. Conclusions: The age of thelarche found by us is similar to that reported in international studies, it comes earlier as weight increases, is delayed as height decreases and is not related to ethnicity.
Subject(s)
Child , Female , Humans , Breast/growth & development , Nutritional Status/ethnology , Puberty, Precocious/ethnology , Age of Onset , Body Mass Index , Chile/ethnology , Cross-Sectional Studies , Indians, South American/ethnology , Indians, South American/statistics & numerical data , Multivariate Analysis , Nutritional Status/physiology , Puberty, Precocious/pathologyABSTRACT
Este artigo tem o objetivo de relatar o diagnóstico e a evolução clínica de um paciente de 15 anos portador de uma disfunção congênita da esteroideogênese adrenal, que pode apresentar-se como hipertensão arterial de diagnóstico muitas vezes tardio (adolescência), virilização ou formas perdedoras de sal (nascimento e infância).
Subject(s)
Humans , Male , Adolescent , Adrenal Hyperplasia, Congenital , Adrenal Hyperplasia, Congenital , Hypertension/complications , Hypertension/drug therapy , Hypertension/metabolism , Adrenocorticotropic Hormone/metabolism , Puberty, Precocious/enzymology , Puberty, Precocious/pathologyABSTRACT
Se reporta el caso de una niña de 3 años de edad con historia de virilización precóz, en la cual lo más llamativo fueron la aparición del vello pubiano, la cliteromegalia con fusión labioescrotal y la aceleración de la velocidad de crecimiento con edad esquelética avanzada (7 años), que avanzó 11.1cm en 1 año, correspondiente entonces a 11 años cuando sólo tenía 4 años+8 meses. El sulfato de dehidroepiandrosterona y al testosterona libre en suero con sus metabolitos urinarios (17-cetosteroides)fueron los andrógenos que se encontraron elevados por encimas de los valores del adulto. El precursor del cortisol(17-alfa-hidroxiprogesterona) estuvo dentro de lo normal. El diagnóstico inicial hiperplasia adrenal congénita indujo a la terapia supresiva con cortisona y dexametasona que conllevaron a su vez a la aparición de un Sindrome de Cushing iatrogénico. La falta de supresión de la actividad androgénica fue la nueva orientación diagnóstica de tumor adrenal, que se confirmó con estudios de ecosonografía, tomografía axial computarizadas y resonancia magnética nuclear en la suprarenal izquierda. El tumor fue extraido por cirugía y la biopsia estableció un"adenoma cortical de la glándula adrenal". La evolución post-operatoria indica que aun cuando hay señales de buen pronóstico, puede haber recurencia o el inicio de una pubertad precoz isosexual
Subject(s)
Child, Preschool , Humans , Female , Adenoma/pathology , Adenoma/surgery , Puberty, Precocious/complications , Puberty, Precocious/pathologyABSTRACT
Se presentan 5 casos de pubertab precoz, estudiados en el Hospital de niños "J.M de los Ríos" de Caracas, todos del sexo masculino, entre 4 y 7 años de edad, con macrogenitosamía precoz, cambio de voz, cefalea, mareos y trastornos psiquiátricos en 2 de ellos. Los cuales fueron evaluados por el Servicio de Neurocirugia. Todos secundarios a lesiones intracraneanas. T.A.C. mostró lesión de ocupación de espacio supraselar en 3 e hidrocefalia congénita en 1 por T.A.C. y en 1 por ventriculografía. Las dosificaciones hormonales demostraron elevación de la hormona luteinizante, gonadotrofina coriónica, testosterona, folículo estimulante, androsterona, dihidroepi-androsterona en 4 de los casos. Recibieron tratamiento radioterápico y quimioterápico 3 casos, con detención de la pubertad precoz en 2 y en 1 caso se realizó orquiectomía bilateral. Seguimiento total: 2 1/2 y 7 años