Pubertad precoz relacionada con la pandemia por COVID-19. Encuesta a endocrinólogos pediátricos argentinos / Precocious puberty in relation to the COVID-19 pandemic. A survey among Argentine pediatric endocrinologists

Introducción. La pubertad se manifiesta inicialmente por la aparición de los caracteres sexuales secundarios, como consecuencia de cambios hormonales que progresivamente conducen a la madurez sexual completa. En Argentina y el mundo, la pandemia ocasionada por el coronavirus SARS-CoV-2 generó un confinamiento que pudo haber interferido en el inicio y tempo del desarrollo puberal. Objetivo. Describir la percepción de los endocrinólogos pediatras del país sobre las consultas por sospecha de pubertad precoz y/o pubertad de rápida progresión durante la pandemia. Materiales y métodos. Estudio descriptivo, observacional, transversal. Encuesta anónima a endocrinólogos pediatras pertenecientes a la Sociedad Argentina de Pediatría y/o a la Asociación de Endocrinología Pediátrica Argentina, en diciembre de 2021. Resultados. Respondieron la encuesta 83 de 144 endocrinólogos pediátricos (tasa de respuesta 58 %). Todos consideraron que aumentó la consulta por desarrollo precoz o temprano, ya sea en sus variantes telarca precoz (84 %), pubarca precoz (26 %) y/o pubertad precoz (95 %). El 99 % acuerda con que se ha dado en mayor medida en niñas. La totalidad de los encuestados también considera que aumentó el diagnóstico de pubertad precoz central. El 96,4 % considera que ha aumentado el número de pacientes tratados con análogos de GnRH. Conclusión. Nuestros resultados sobre la percepción de endocrinólogos pediatras coinciden con datos publicados en otras regiones sobre el aumento del diagnóstico de pubertad precoz durante la pandemia por COVID-19. Se reafirma la necesidad de generar registros nacionales de pubertad precoz central, difundir las evidencias para su detección y abordaje oportuno.

Introduction. Puberty is manifested initially by the onset of secondary sexual characteristics as a result of hormonal changes that progressively lead to complete sexual maturity. In Argentina and worldwide, the lockdown resulting from the SARS-CoV-2 pandemic may have interfered in the onset and timing of pubertal development. Objective. To describe the perception of pediatric endocrinologists in Argentina regarding consultations for suspected precocious and/or rapidly progressive puberty during the pandemic. Materials and methods. Descriptive, observational, cross-sectional study. Anonymous survey among pediatric endocrinologists members of the Sociedad Argentina de Pediatría and/or the Asociación de Endocrinología Pediátrica Argentina administered in December 2021. Results. Out of 144 pediatric endocrinologists, 83 completed the survey (rate of response: 58%). All of them considered that consultation for precocious or early puberty increased, either in terms of early thelarche (84%), early pubarche (26%), and/or precocious puberty (95%). Ninety-nine percent agreed that this has occurred to a greater extent in girls. All survey respondents also consider that the diagnosis of central precocious puberty has increased. In total, 96.4% of respondents consider that the number of patients treated with GnRH analogs has increased. Conclusion. Our results about the perception of pediatric endocrinologists are consistent with data published in other regions on the increase in the diagnosis of precocious puberty during the COVID-19 pandemic. We underscore the need to develop national registries of central precocious puberty, and to disseminate the evidence for a timely detection and management

Pubertad precoz y pubertad rápidamente progresiva durante el confinamiento por la pandemia por COVID-19 / Rapidly progressive precocious puberty during the COVID-19 lockdown

Introducción. Durante la pandemia por COVID-19, observamos un aumento de consultas por pubertad precoz (PP). Nuestro objetivo fue determinar la frecuencia de PP y su progresión antes y durante la pandemia. Métodos. Estudio retrospectivo, observacional y analítico. Se evaluaron las historias clínicas de los pacientes que consultaron en Endocrinología Infantil entre abril de 2018 y marzo de 2021. Se analizaron las consultas por sospecha de PP durante la pandemia (período 3) y se compararon con 2 años previos (períodos 1 y 2). Se recolectaron datos clínicos y estudios complementarios de la evaluación inicial y su progresión. Resultados. Se analizaron 5151 consultas. Se observó un aumento de consultas por sospecha de PP durante el período 3 (21 % vs.10 % y 11 %, p <0,001). Los pacientes que consultaron por sospecha de PP durante el período 3 aumentaron 2,3 veces (80 vs. 29 y 31, p <0,001). El 95 % fueron niñas; esa población fue analizada. Se incluyeron 132 pacientes que fueron similares en edad, peso, talla, edad ósea y determinaciones hormonales en los 3 períodos. En el período 3, se observó un menor índice de masa corporal, mayor porcentaje de estadio mamario Tanner 3-4 y mayor longitud uterina. Se indicó tratamiento al diagnóstico en el 26 % de los casos. En el resto, se controló su evolución. Durante el seguimiento, se observó una evolución rápidamente progresiva con mayor frecuencia durante el período 3 (47 % vs. 8 % vs. 13 %; p: 0,02). Conclusiones. Evidenciamos un aumento de la PP y una evolución rápidamente progresiva en niñas durante la pandemia.

Introduction. During the COVID-19 pandemic, an increase in consultations for precocious puberty (PP) was observed. Our objective was to determine the frequency of PP and its progression before and during the pandemic. Methods. Retrospective, observational, analytical study. The medical records of patients who consulted with the Department of Pediatric Endocrinology between April 2018 and March 2021 were assessed. Consultations for suspected PP during the pandemic (period 3) were analyzed and compared to the 2 previous years (periods 1 and 2). Clinical data and ancillary tests done in the initial assessment and PP progression information were collected. Results. Data from 5151 consultations were analyzed. An increase in consultations for suspected PP was observed during period 3 (21% versus 10% and 11%, p < 0.001). Patients who consulted for suspected PP during period 3 increased 2.3-fold (80 versus 29 and 31, p < 0.001). In total, 95% were female; this was the population analyzed. We included 132 patients with similar age, weight, height, bone age, and hormonal characteristics in the 3 periods. During period 3, a lower body mass index, a higher percentage of Tanner breast stage 3­4, and a greater uterine length were observed. Treatment was indicated upon diagnosis in 26% of the cases. In the rest, their evolution was monitored. During follow-up, a rapidly progressive course was observed more frequently in period 3 (47% versus 8% versus 13%, p: 0.02). Conclusions. We observed an increase in PP and a rapidly progressive evolution in girls during the pandemic.

Análisis de la incidencia de pubertad precoz central tratada con análogos de hormona liberadora de gonadotrofina. Impacto de la pandemia por COVID-19 / Analysis of the incidence of central precocious puberty treated with gonadotropin-releasing hormone analogs. Impact of the COVID-19 pandemic

Introducción. Desde inicios de la pandemia por coronavirus 2019 (COVID-19), fue comunicado en varios países un incremento de las consultas de niñas con pubertad precoz central idiopática (PPCI), sin que contáramos con datos argentinos. Este aumento estaría vinculado con los cambios en el estilo de vida y los niveles de estrés resultantes del aislamiento que afectó particularmente a la población infantil. Objetivos. 1) Describir la evolución de la incidencia de PPCI con requerimiento de inhibición del eje hipotálamo-hipófiso-gonadal (EHHG) en niñas entre 2010 y 2021 en una cohorte del Área Metropolitana de Buenos Aires. 2) Comparar las características de las niñas, con dicho diagnóstico realizado durante la pandemia, con las de un grupo control. Métodos. Serie de tiempo interrumpida y estudio de casos y controles. Resultados. La incidencia anual fue estable entre 2010 y 2017. Desde 2017 hubo un ascenso anual que promedió el 59,9 % (IC95 % 18,6-115,5) y pareciera haberse acelerado durante la pandemia. Constatamos asociación entre haber desarrollado PPCI y haber requerido tratamiento inhibitorio entre el 01 de junio de 2020 y el 31 de mayo de 2021, y dos variables: edad de menarca materna (OR 0,46; IC95 % 0,28-0,77) y antecedente familiar de PPCI (OR 4,42; IC95 % 1,16-16,86). Conclusión. Evidenciamos desde 2017 un aumento significativo en la incidencia de PPCI con requerimiento de inhibición del EHHG. El incremento en la exposición a diversos desencadenantes ambientales durante la pandemia por COVID-19 podría haber ejercido mayor influencia en las niñas con alguna predisposición genética.

Introduction. Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, consultations of girls with idiopathic central precocious puberty (ICPP) increased in several countries, but there were no data from Argentina. This increase may be related to changes in lifestyle and stress levels resulting from the lockdown, which particularly affected the child population. Objectives. 1) To describe the progression of the incidence of ICPP requiring inhibition of the hypothalamic- pituitary-gonadal (HPG) axis in girls between 2010 and 2021 in a cohort from the Metropolitan Area of Buenos Aires. 2) To compare the characteristics of girls diagnosed with ICPP during the pandemic with those of a control group. Methods. Interrupted time-series and case-control study. Results. The annual incidence remained stable between 2010 and 2017. Since 2017, it increased to an average of 59.9% (95% CI: 18.6­115.5) and appears to have accelerated during the pandemic. We found an association between ICPP and requiring inhibitory treatment between June 1 st, 2020 andMay 31 st, 2021 and 2 variables: maternal age at menarche (OR: 0.46, 95% CI: 0.28­0.77) and family history of ICPP (OR: 4.42, 95% CI: 1.16­16.86). Conclusion. We evidenced a significant increase in the incidence of ICPP with requirement of HPG axis inhibition since 2017. Increased exposure to various environmental triggers during the COVID-19 pandemic may have had a greater influence in girls with some genetic predisposition.

Dedicated sellar magnetic resonance imaging protocols without contrast enhancement in girls with central precocious puberty: prevalence of pathologic lesions and clinical correlation

ABSTRACT Objective: Contrast-enhanced brain magnetic resonance imaging (MRI) is routinely performed in children with central precocious puberty (CPP). We evaluated the value of a dedicated sellar MRI protocol without contrast enhancement in girls with CPP. Subjects and methods: This study included 261 girls diagnosed with CPP. We performed sellar MRI scanning without gadolinium enhancement of the hypothalamic-pituitary area (HPA) at the pituitary level, including additional T2-weighted imaging of whole-brain scans to check for other lesions. We evaluated the prevalence of intracranial lesions via this MR protocol. In addition,the correlation between the clinical parameters and morphology of the pituitary gland on the images was assessed. Results: Intracranial lesions were detected in 17 (6.5%) of the 261 girls. Of the 17 girls with abnormalities, 16 (94.1%) had findings in brain areas other than the HPA. The weight, height, Tanner stage of patients were significantly (p < 0.05) higher in the group with greater pituitary height. Patient weight and height, Tanner stage of breast development, and luteinizing hormone (LH) levels were significantly (p < 0.05) greater in those with a higher pituitary grade as determined on sellar MRI. Conclusion: A dedicated unenhanced sellar MRI protocol provides valuable information on brain lesions and pituitary morphology. We found a significantly low prevalence of brain lesions among girls with CPP. Analysis of the height or shape of the pituitary gland on sellar MRI revealed significant correlations with the weight, height, Tanner stage, and LH levels of the patients.

El adelanto en la telarquia y edad de la menarquia se relacióna con la malnutrición por exceso en niñas chilenas pero no en varones: estudio de base poblacional / The advance in thelarche and age of menarche is related to malnutrition by excess in Chilean girls but not in boys: population-based study

Introduction: Puberty normally begins after 8 years in girls and 9 years in boys. Objective: To determine the prevalence of signs of precocious puberty (PP), breast development in girls, premature gonadal development (PGD), premature adrenarche (PA), menarche age (MA) and its association with nutritional status (NS). Material and Methods: From a sample of 3.010 children from 5 to 14 years randomly selected in Santiago of Chile were chosen a subsample of 873 kids according to the cutoff to define PP. Survey was applied to obtain MA. Logistic regression were used to evaluate the relationship between PP and NS. Results: In boys the prevalence of PGD and PP was 8.55% and 3.16% respectively, no relationship was found with nutritional status In girls the prevalence of breast development and PA was 8.13% and 0.9% respectively. Only there be association between PP and NS in women: with a prevalence of 1,2%, 13,9% and 21,1% in well-nourished, Overweight and obesity are at greater risk of showing PP compared with eutrophic girls with an OR of 25,5 (IC 95% 3,2-203,0) and 46.93 (IC 95% 6,1-361,5). MA was 12,01 ± 0,94 years in eutrophic girls and 11,40 ± 0,96years in obese girls (p< 0,05). Conclusion: There was a positive correlation in females between overweight and obesity an PP and MA. There is a secular trend in MA, to compare these findings with other national studies. Obesity could have an important role in explaining the advancement observed in pubertal development.

Introducción: El desarrollo puberal se inicia normalmente después de los 8 años en niñas y de los 9 años en varones. Objetivo: Estimar la prevalencia de signos de pubertad precoz (sPP): crecimiento genital (CG) en varones, telarquia en niñas y vello púbico (VP) en ambos sexos; y determinar edad de la menarquia (EM) en una muestra de escolares de Santiago de Chile), y evaluar la asociación de estas variables con el estado nutricional (EN). Material y Métodos: Se examinaron 3.010 escolares de clase media baja de 6 a 14 años, pertenecientes a 10 colegios de Santiago de Chile y seleccionados aleatoriamente. En todos ellos se consignó peso, talla, IMC y desarrollo puberal según Tanner. Se aplicó una encuesta a los padres para obtener la EM a la población total de mujeres (n= 1.433). Para determinar sPP se analizaron por separado los 867 niños (62% mujeres) menores a la edad establecida como puntos de corte para definir PP. Se utilizó regresión logística para determinar la asociación existente entre sPP y el EN. Resultados: En varones la prevalencia de CG y VP fue de 8,55% y 3,16% y no se asocio al EN. La prevalencia de telarquia y VP en niñas fue de 8,13% y 0,9% respectivamente. Se observó una fuerte asociación entre telarquia y EN con prevalencias de 1.2%, 13.9% y 21.1% en eutróficas, sobrepeso y obesas, respectivamente (p< 0,0001) (Gráfico 1). La presencia de sobrepeso y/o obesidad otorgan un mayor riesgo de presentar telarquia, vs comparación con las niñas eutróficas con un OR de 25,5 (IC 95% 3,2-203,0) y 46.93 (IC 95% 6,1-361,5), respectivamente. La EM fue 12,01 ± 0,94 años en niñas eutróficas siendo de 11,40 ± 0,96 años en niñas obesas (p< 0,05). Conclusión: Se observó una correlación positiva solo en el sexo femenino entre malnutrición por exceso, telarquia precoz y EM. Se observa una tendencia secular en la EM al comparar los hallazgos con otros estudios nacionales.

Risco cardiovascular em meninas com pubarca precoce isolada / Cardiovascular risk in girls with isolated premature pubarche

Introdução: Pubarca precoce é o aparecimento de pelos pubianos antes dos 8 anos em meninas e dos 9 anos em meninos, sendo mais frequente em meninas. Entre suas etiologias, a adrenarca precoce é a mais comum. A literatura traz associações entre pubarca precoce e fatores de risco para doenças cardiovasculares Objetivos: O presente estudo pretende avaliar os fatores de risco para doenças cardiovasculares em meninas com pubarca precoce isolada. Métodos: Trata-se de um estudo observacional utilizando dados secundários extraídos de prontuários médicos de 41 meninas com diagnóstico de pubarca precoce isolada entre 1999 e 2013, acompanhadas em policlínica universitária na área de endocrinologia pediátrica. As variáveis de estudo foram: peso, estatura, índice de massa corporal, pressão arterial, peso ao nascimento, idade óssea, dislipidemia, glicemia e insulina de jejum e androgênios basais. Resultados: A média de idade foi de 7,8±1,4 anos. A frequência de excesso de peso foi de 42,1%, baixo peso ao nascimento de 13,1%, pressão arterial elevada de 17,3% e elevação de colesterol total em 45,8%. A idade óssea foi superior à cronológica em 81,8%. Não foram verificadas hiperinsulinemia nem resistência insulínica. O hiperandrogenismo acometeu aproximadamente um terço das pacientes. Conclusões: A maioria das pacientes apresentou ao menos um fator de risco para doença cardiovascular, sendo os mais prevalentes o excesso de peso e a dislipidemia. Aproximadamente 1/3 das pacientes apresentavam hiperandrogenismo (AU)

Introduction: Premature pubarche is the appearance of pubic hair before 8 years in girls and 9 years in boys, being more frequent in girls. Among its etiologies, precocious adrenarche is the most common. The literature shows associations between precocious pubarche and risk factors for cardiovascular diseases. Aim: This study intends to evaluate the risk factors for cardiovascular diseases in girls with isolated premature pubarche. Methods: This is an observational study using secondary data extracted from medical records of 41 girls diagnosed with early pubarche between 1999 and 2013, followed by a university polyclinic in the area of pediatric endocrinology. The study variables were weight, height, body mass index, blood pressure, birth weight, bone age, dyslipidemia, glycemia, and fasting insulin and basal androgens. Results: Mean age was 7.8 ± 1.4 years. The frequency of overweight was 42.1%, low birth weight 13.1%, high blood pressure 17.3%, and total cholesterol elevation 45.8%. Bone age was higher than chronological age in 81.8%. No hyperinsulinemia and insulin resistance were observed. Hyperandrogenism affected approximately one-third of the patients. Conclusions: Most patients presented at least one risk factor for cardiovascular disease, the most prevalent being overweight and dyslipidemia. Approximately 1/3 of the patients had hyperandrogenism (AU)

Telarquia precoz en la niñez: causas y estudio / Premature thelarche in childhood: causes and study

Se define Telarquía Precoz como la aparición del botón mamario antes de los ocho años en ausencia de otros signos de pubertad. En los primeros años de vida puede ser secundaria al fenómeno de la minipubertad, mientras que en la etapa escolar podría ocurrir debido a la interacción entre disruptores endocrinológicos y la obesidad. Una parte importante se mantiene estacionaria o revierte, mientras que un pequeño porcentaje puede evolucionar hacia la pubertad precoz. Se debe realizar una anamnesis y examen físico adecuado buscando otros signos puberales, una buena curva de crecimiento y puede complementarse con imágenes y con un seguimiento para intentar determinar aquellas pacientes que evolucionarán hacia la pubertad precoz.

Premature thelarche is defined as the breast bud appearance before eight years, without other signs of puberty development. During the first years of life it can be secondary to the minipuberty phenomenon, while during school period it's usually secondary to the interaction between endocrine disruptors and obesity. Although most of cases remain stable or regresses, a small percentage can evolve to precocious puberty. An appropriate clinical history and physical exam looking for other signs of precocious puberty must be held, complemented with the correspondent follow up and images studies, in order to diagnose patients that will evolve to precocious puberty.

KISS1 Gene Polymorphisms in Korean Girls with Central Precocious Puberty

Kisspeptin/G-protein couple receptor-54 (GPR54) system plays a key role in the activation of the gonadotropic axis at puberty. Central precocious puberty (CPP) is caused by the premature activation of hypothalamic gonadotropin-releasing hormone secretion. This study was aimed to identify KISS1 gene variations and to investigate the associations between KISS1 gene variations and CPP in Korean girls. All coding exons of KISS1 gene were sequenced in Korean girls with CPP (n = 143) and their healthy controls (n = 101). Nine polymorphisms were identified in KISS1 gene. A novel single-nucleotide polymorphism (SNP), 55648176 T/G, was identified for the first time. SNP 55648184 C/G and 55648186 -/T were detected more frequently in CPP group than in control group. SNP 55648176 T/G was detected less frequently in CPP group than in control group. Haplotype GGGC-ACCC was detected less frequently in CPP group. The genetic variations of KISS1 gene can be contributing factors of development of CPP. The association between the gene variations and CPP should be validated by further evidence obtained from large-scaled and functional studies.

KISS1 Gene Polymorphisms in Korean Girls with Central Precocious Puberty

Kisspeptin/G-protein couple receptor-54 (GPR54) system plays a key role in the activation of the gonadotropic axis at puberty. Central precocious puberty (CPP) is caused by the premature activation of hypothalamic gonadotropin-releasing hormone secretion. This study was aimed to identify KISS1 gene variations and to investigate the associations between KISS1 gene variations and CPP in Korean girls. All coding exons of KISS1 gene were sequenced in Korean girls with CPP (n = 143) and their healthy controls (n = 101). Nine polymorphisms were identified in KISS1 gene. A novel single-nucleotide polymorphism (SNP), 55648176 T/G, was identified for the first time. SNP 55648184 C/G and 55648186 -/T were detected more frequently in CPP group than in control group. SNP 55648176 T/G was detected less frequently in CPP group than in control group. Haplotype GGGC-ACCC was detected less frequently in CPP group. The genetic variations of KISS1 gene can be contributing factors of development of CPP. The association between the gene variations and CPP should be validated by further evidence obtained from large-scaled and functional studies.

Short stature and an interesting association.

Untreated hypothyroidism in children usually results in delayed puberty, but juvenile hypothyroidism causes isosexual precocious puberty in a rare syndrome called Van Wyk Grumbach syndrome, with a complete reversal to the pre pubertal state following thyroid hormone replacement therapy. We report here, a 7-year-old girl who presented with short stature, constipation and isosexual precocious puberty due to the long standing untreated severe hypothyroidism with this syndrome.

Pubarquia precoz: Experiencia en 173 casos / Precocious pubarche: Experience in 173 cases

Background: Precocious pubarche (PP), defined as the development of sexual pubic hair before 8 years of age in females and before 9 years in males, is usually a benign condition but it can also be the first sign of an underlying disease. Aim: To analyze the etiology andperform a short term follow up in a cohort of patients with PP. Material and methods: A group of 173 patients (158 females) consulted for PP with a mean age of 7.4±0.1 years. These patients were followed between 15 to 60 months. Anthropometric measurements, bone age, serum levels of total testosterone, 17 OH progesterone (17 OHP) and dehydroepiandrosterone sulphate (DHEAS) were evaluated. Results: Mean birth weight and length was 3024.1±50.5 g and 48.5±0.3 cm,respectively. Ten percent of children were small for gestational age at birth. Bone age was accelerated by 1.1±0.01 years. One hundred and twelve patients were classified as having idiopathicPP (64.7%; 105 females), 29 as central precocious puberty (16.8%; only females), 16 as exaggerated adrenarche (EA 9.2%; 13 females) and 16 as non classical adrenal hyperplasia (9.2%; 11 females). Conclusions: PP represents a common and usually benign sign. However, 26% of cases had apathologic underlying condition. Therefore, all children with PP should be evaluated by a pediatric endocrinologist. Low birth weight was not frequent in this cohort and these patients did not show EA

Avanços diagnósticos e terapêuticos da puberdade precoce em meninas / Advances in the diagnosis and treatment of precocious puberty in girls

A puberdade é considerada precoce em meninas quando aparece antes dos oito anos, incidindo em uma criança para cada 5.000 a 10.000 que têm desenvolvimento normal. Pode ser classificada em central ou periférica. O diagnóstico procura caracterizar a etiologia, evidenciar o estádio da puberdade e definir a melhor terapêutica. No diagnóstico, a dosagem de gonadotrofinas (basais e/ou estimuladas) é o exame de escolha para o início da investigação. No tratamento, há mais de 20 anos são utilizados os análogos de GnRH, principalmente por via intramuscular. As formulações de depósito, aplicadas a cada quatro semanas, são as mais utilizadas. Implantes subcutâneos com análogos de GnRH têm sido considerados promissores. Pacientes com puberdade precoce e reduzida velocidade de crescimento (VC), com o uso dos análogos, têm sido tratadas associando-se o hormônio de crescimento recombinante humano (rhGH), duplicando habitualmente a VC sem acelerar o ritmo de maturação óssea. O uso da metformina em meninas com baixo peso ao nascer e pubarca precoce ou com puberdade iniciada entre oito e nove anos, porém com previsão de menarca precoce e baixa estatura, pode levar à normalização da evolução puberal, ganho de estatura final, além de diminuição do índice de massa corpórea.

Adelanto de la pubertad en Chile y el mundo / Timing of puberty: secular trend toward earlier development in Chile and variations around the world

La menarquia se ha adelantado progresivamente desde mediados del siglo XIX, hecho conocido como tendencia secular de la menarquia, fenómeno que parece ser una característica evolutiva del ser humano en relación al mejoramiento de las condiciones de vida. Sin embargo, durante los últimos treinta años la edad de la menarquia se ha mantenido estable. A diferencia de la menarquia, la telarquia está ocurriendo a una edad más precoz que hace algunas décadas y es frecuente encontrar casos de telarquia aislada en niñas menores de 8 años. En el varón, en cambio, no hay evidencias de que su desarrollo esté ocurriendo más tempranamente. En el presente artículo, se discute la etiología del adelanto puberal y los factores que se deben tomar en cuenta en las pacientes para decidir un eventual estudio y tratamiento.

Urgences gynecologiques prepubertaires : aspects diagnostiques et therapeutiques a propos de 239 cas colliges dans le service de Gynecologie et d'Obstetrique du CHu de Treichville

Nous avons a partir d'une etude retrospective s'etendant sur une periode de 11 ans; etudie les pathologies gynecologiques pre pubertaires recensees aux urgences gynecologiques du CHU de Treichville (ABIDJAN); chez 239 patientes agees de 0 a 9 ans. Notre etude i. etait axee sur l'analyse des donnees epidemiologiques et sur les aspects diagnostiques et therapeutiques. Elle a permis de faire les constatations suivantes: -les pathologies gynecologiques prepubertaires sont de frequence tres faible; dans notre service; representant 0.76pour cent des admissions aux urgences; -le prolapsus de l'uretre est la pathologie gynecologique prepubertaire la plus frequente (38.9pour cent); suivi des traumatismes genitaux accidentels (14.2pour cent); des violences sexuelles (13.4pour cent) et des infections vulvovaginales (12.1pour cent). Les methodes therapeutiques ont ete soit medicales (43.5 pour cent) avec l'administration d'antibiotique; d'anti inflammatoire; d'antiseptique local; de creme d'oestrogene; soit chirurgicales (41.4pour cent) par des methodes de ligature du prolapsus de l'uretre; de suture genitale et d'extraction de corps etranger. La mise en place d'une cellule specifique integree contribuerait a une meilleure prise en charge des pathologies gynecologiques pre pubertaires

Puberdade precoce central idiopática em meninas no estado da Bahia / Idiopathic central precocious puberty in girls from Bahia, Brazil

INTRODUÇÃO: Embora os efeitos benéficos do tratamento com análogos de GnRH (GnRHa) na puberdade precoce central (PPC) estejam estabelecidos, aspectos clínicos podem variar em função do grupo racial. OBJETIVO E MÉTODOS: Descrever o perfil de 175 meninas com PPC idiopática tratadas com GnRHa na Bahia, Brasil. RESULTADOS: Houve predomínio do grupo racial mulato (73,6 por cento). A puberdade iniciou-se aos 6,3 ± 0,1 anos. Ao diagnóstico, as crianças apresentavam estatura de 2,2 ± 0,1 DP e índice de massa corpórea (IMC) de 1,5 ± 0,1 DP (> 2 DP em 32 por cento), estando este, inversamente associado (R= -0,20, p= 0,008) à idade no início da puberdade. As idades cronológica e óssea foram de 8,4 ± 0,1 anos e 10,3 ± 0,1 anos, respectivamente, ao início do tratamento. No seu término (n= 52), idade, IMC e estatura (n= 52) foram 10,6 ± 0,1 anos, 1,6 ± 0,2 DP e 1,9 ± 0,2 DP, respectivamente. CONCLUSÃO: Apresentação clínica e evolução puberal foram similares a outros estudos, independente do grupo racial. O tratamento com GnRHa não resultou em ganho de peso significativo na amostra estudada.

Earlier onset of pubertal maturation in Thai girls.

BACKGROUND: Recent studies in the USA and Hong Kong demonstrated the onset of puberty in girls has shifted toward a younger age. Based upon previous studies on variations of pubertal maturation in Thai girls, the secular trend has also moved toward an earlier age. The latest study in 1995 revealed the mean age of menarche was 12.3 years. OBJECTIVES: To identify the onset of puberty, menarche and pubarche in female children and adolescents in 2 Bangkok schools. METHOD: Three hundred school girls aged 9-19 years were enrolled in the study. Data were collected from January 1997 through December 1999. Assessment of pubertal staging by Tanner's criteria was performed by a trained pediatrician. All were in good physical health and had normal height and weight. The median ages of thelarche, menarche and pubarche were estimated by probit analysis. All other parameters were expressed as mean +/- SD. RESULTS: The median ages of thelarche and pubarche were 9.4 and 11.1 years, respectively. Two hundred and twenty one girls had experienced menstruation. The median age of menarche was 11.2 years, whereas, the mean age was 12.1 years. Most girls reached near final adult height after 14 years old. CONCLUSION: The secular trend in decline of the ages of thelarche (or puberty) and menarche was observed in Bangkok girls. Further study in a larger population including a younger age group is required to define the current reference interval of onset of puberty.

Pubertad normal y maduración sexual precoz en niñas: experiencia en el Hospital Infantil de México Federico Gómez de 1979 a 1997 / Normal and precocious puberty in girls: experience in Hospital Child of Mexico Federico Gómez of 1979 at 1997

La maduración sexual precoz se considera mundialmente como la aparición de los caracteres sexuales secundarios antes de los 8 años de edad en las niñas, clasificándose en: 1 Pubertad precoz central (PPC) o verdadera cuando aparecen los caracteres sexuales secundarios en una secuencia normal asociada a una activación temprana del eje hipotálamo-adenohipófisis-ovarios. 2. Pubertad precoz periférica (PPP) relacionada con telarca o pubarca prematuras aisladas, aumento de estrógenos, andrógenos o gonadotropinas ectópicas sin maduración del eje. 3. Telarca prematura aislada en la que la actividad estrogénica es leve o moderada; sin incremento de la LH, de la edad ósea y de la velocidad de crecimento. 4. Pubarca prematura aislada, que es muy común, encontrándose producción normal de andrógenos suprarrenales. La pubertad precoz idiopática debe valorarse periódicamente ya que en aglunos casos se han encontrado posteriormente lesiones del sistema nervioso central. La telarca y pubara prematuras aisladas no requieren usualmente tratamiento a menos que evolucionen hacia PPC o PPP; en caso de la primera se incluyen los análogos de GnRH, el acetato de medroxiprogesterona o el acetato de ciproterona, y en la segunda el tratamiento va dirigido a eliminar la causa de la producción de estrógenos