ABSTRACT
Background: At present few data have clearly showed an increased frequency of idiopathic central precocious puberty (CPP) in females during the COVID-19 pandemic. The role of environmental factors is not fully understood and various hypotheses have been formulated. Aims of the Study: To evaluate retrospectively the incidence of newly diagnosed CPP and other pubertal disorders (premature thelarche, early puberty, fast puberty and precocious menarche) in two regions of Italy (Tuscany and Emilia-Romagna) during and after the lockdown for COVID-19. Patients and Methods: The study included 440 females evaluated for pubertal disorders into the Centres of Florence, Parma, Reggio Emilia and Modena between the 1 January 2020 into the 31 December 2021. Subjects with endocrine or chronic diseases were excluded. Monthly incidence rates and clinical features were compared with a control group of patients evaluated for the same problems into 2019. Result(s): Our data confirmed a higher frequency of CPP in females (261 patients, mean age 7.6 +/- 0.6 years, without significant differences between the diagnoses carried out in 2020 and 2021) compared to 2019 (52 cases, mean age 7.5 +/- 0.7 years, p < 0.0001). Interestingly, CPP cases were significantly higher also in the first two months of 2020, so before the start of Italian lockdown and just before the Sars-COV-2 pandemic was declared (21 cases vs. 7 in the same period of 2019;p < 0.0001). Our preliminar data seem also to suggest an increased frequency of the diagnoses of premature thelarche (54 patients in 2021 and 31 patients in 2020 vs 21 patients in 2019, respectively p < 0.0001 and < 0.05;between 2020 and 2021: p < 0.0001), early puberty (31 patients in 2021 and 25 patients in 2020 vs 16 patients in 2019, respectively p < 0.0001 and p < 0.05), fast puberty (20 patients in 2020 vs 5 patients in 2019 and 2021;respectively, p < 0.0001) and precocious menarche (9 patients in 2021 vs 3 patients in 2019 and 4 patients in 2020;p < 0.0001). Conclusion(s): Our data, on the one hand, confirm an increase in the frequency of new cases of CPP during and after the lockdown for COVID-19 pandemic, but also show an increase, albeit differently distributed in these 2 years of epidemic, in other pubertal development disorders. Interestingly, this could delineate different factors involved in the genesis of these disorders. Further studies and insights appear necessary to better explain these aspects.
ABSTRACT
Background: Adrenal insufficiency (AI) is a rare condition caused by an inadequate production of glucocorticoids. Preliminary data in adults suggest that AI could be associated with an increased susceptibility to infections;moreover, AI patients are at risk to develop a severe course of infectious diseases and to experience a life-threatening adrenal crisis. The aim of our study is to evaluate the severity and the outcome of COVID-19 in pediatric AI patients in comparison to subjects affected with other endocrinopathies not involving adrenal gland. Patients and Methods: This was a retrospective, multicenter study involving 11 Italian tertiary-centers of pediatric endocrinology. Data regarding symptoms, severity and duration of the disease, the need to increase the dose or receive parenteral administration of hydrocortisone and the outcome were collected through a telephone interview and review of patient's medical files. From March 2020 to October 2021, 80 children with a history of COVID-19 were collected: 49 subjects affected by AI (42 primary AI, 7 central AI) and 31 subjects as controls. Result(s): Mean age was comparable between patients and controls (11.4+/-4.4 years vs 10+/-3.5 years, respectively). The frequency of signs/symptoms during COVID-19 in AI patients was as follows: fever 68%, rhinorrhea 34%, headache 34%, sore-throat 30%, cough 28%, anosmia/ageusia 21%. Less common symptoms were characterized by arthralgia, abdominal pain, diarrhea and vomiting. The severity of infection was comparable between patients and controls: paucisymptomatic 40.8% vs 25.8%;mild 55.1% vs 61.3%;severe 4.1% vs 12.9%, respectively (Chi-square=0.19). Time between the first positive nasopharyngeal swab and the first negative one in patients vs controls was: <=15 days, 39% vs 56.6%;>15 days, 61% vs 43.3%, showing a tendency to longer infection in AI children, although this difference did not reach statistical significance (Chi-square=0.14). In 64% of AI patients the dose of hydrocortisone was increased during the infection and in 6.4% parenteral hydrocortisone was needed. 94% of AI subjects did not require hospitalization while only 6% were hospitalized with a complete recovery in 100% of cases. Within the entire cohort of AI subjects, 2 children (4%) experienced an adrenal crisis during infection. No fatal events occurred. Conclusion(s): Our data, suggest that children with AI adequately treated are not at increased risk of severe course of COVID-19. In comparison to controls, subjects with AI have a slightly longer duration of the disease, although this data need to be confirmed on larger sample of patients.