ABSTRACT
Objectives The COVID-19 pandemic caused stress, social isolation and physical inactivity in many. We proposed to review anthropometric/biochemical profiles in girls seen for precocious puberty (PP) (ages 5-8 years) during the pandemic (3/2020- 3/2021) compared to girls seen in the prior 2 years (2/2018-2/2020) and look at environmental and psychosocial impacts. Methods A retrospective chart review of the girls prepandemic (Pre-PD) were compared to those seen during the pandemic (PD). Criteria for PP: luteinizing hormone (LH range: 0.02-0.3 mIU/L, ECLIA, Esoterix) with >0.3 defined as pubertal;estradiol (range <36 pg/ml for age 7-9 years, LCMS, ARUP) with >=36.0 pg/ml defined as pubertal;follicle stimulating level (FSH 0.4- 6.5 IU/L ECLIA, ARUP). Girls with isolated adrenarche were excluded. Pelvic ultrasound with ovarian volumes (OVs>1cc considered pubertal) and MRI pituitary were done as indicated. Bone age/chronological age ratio (BA/CA) >1 was considered advanced. A Covid-19 impact survey was sent via a HIPAA compliant REDCap link to assess activity, sleep, and psychosocial stressors, distress on 0-10 scale (mild 0-4, moderate 5-7, severe 8-10) to families. T-tests and bivariate correlations were run (SPSS Ver 21). Results In total 56 subjects were included (pre-PD=23 vs. PD=33). A 30% increase in puberty referrals was noted during the pandemic. Weight (mean+ SD: Pre-PD vs. PD: 26.8+/-5 vs. 26.9+/-5.7 kg) and BMI (17.3+/-2.3 vs.16.8+/-2.3kg/m2). Estradiol (9.7+/-7.5 vs.21.9+/-16.6 pg/ml;p-value =0.006), random LH (1 vs. 15) were pubertal. OVs (1.75+/-1.1 vs. 2.75 cc) and BA/CA (1.1+/- 0.4 vs. 1.0+/-0.5) were seen in the two groups respectively. There was a correlation between estradiol levels and OVs in PD group (r= 0.5;p=.05). Survey results showed 61% of subjects used remote learning, 55% spent >4 hours on social media (Tik Tok, WhatsApp, etc.), 50% reported no exercise and 33% reported no social interaction. Stress was moderate with a parental report of 5.4/10, (50%essential workers, 18% lost jobs) & children reported stress level of 4.8/10. Conclusions We report an increased incidence of PP during the pandemic (perhaps due to a delay in evaluation) and a more advanced puberty (higher estradiol levels and greater OVs) compared to Pre-PD patients. Though weight gain, potentially due to inactivity, did not appear to contribute, we believe that stress, excessive social media use and/or isolation could be factors which contributed to the increased incidence of PP during the pandemic.
ABSTRACT
Introduction: Physical examination remains the cornerstone of medical practice. However, its importance has been underestimated during COVID-19 pandemic because of concerns related to exposure risk and use of personal protective equipment. Solitary median maxillary central incisor (SMMCI) may be an isolated clinical trait or associated with other anomalies and endocrine pathologies including hypopituitarism, hypothyroidism, isolated growth hormone (GH) deficiency, precocious or delayed puberty, short stature without GH abnormalities. Aim(s): The aim of this case presentation is to underline the significance of clinical examination, as in SMMCI, an important clinical finding that may lead to an early diagnosis of hidden endocrine abnormalities. Material(s) and Method(s): A 78/12-year-old girl was hospitalised because of an episode of acute headache with walking instability. Her past medical history was uneventful except for premature adrenarche since the age of 56/12 years. A paediatric endocrinologist had estimated her 2 years before, at the onset of the COVID-19 pandemic and ordered hormone assays and a Synachten test. Because of her past medical history and the positive family history for type 2 diabetes, she underwent a detailed hormone laboratory evaluation including oral glucose tolerance test (OGTT) and LHRH test. Furthermore, because of the borderline response in 17-hydroxyprogesterone following ACTH stimulation, CYP21A2 gene analysis was performed. Result(s): Her clinical examination revealed excessive body mass index (18.9 kg/m2, 90th percentile) and B I and PH II-III Tanner stage with axillary hair and odor. OGTT revealed insulin resistance (HOMA-IR 3.38). Based on the increased LH response in GnRH test (LH at 30 min 3.8 IU/L) in association to the increased ovarian volume (3.25 and 5.3 ml with 6 and 9 follicles respectively), she was diagnosed with central precocious puberty (CPP). At the time of final clinical and laboratory overview by the Chief of the Unit, the girl was asked to put off her mask, unraveling a SMMCI, a finding not having been identified and correctly evaluated until then. Consequently, a pituitary gland magnetic resonance imaging (MRI) was mandatory, revealing ectopic posterior pituitary at the pituitary stalk with hypoplasia of anterior pituitary, possibly implicated in the CPP aetiology. The patient was prescribed triptorelin and is on regular endocrine follow-up. Conclusion(s): SMMCI, so easily diagnosed, may be the cardinal clinical feature guiding further physical, endocrine laboratory and imaging investigation and leading to early diagnosis of endocrine pathology. Clinical examination remains the key of paediatric endocrine evaluation, overcoming any potential risk in the era of COVID-19.
ABSTRACT
OBJECTIVE: To assess the influence of longitudinal weight gain from 0 to 4 years old on dehydroepiandrosterone sulphate (DHEAS) levels at 7 years old. DESIGN: DHEAS levels were measured at 7 years old in a subsample of 587 children from the Generation XXI birth cohort. Weight trajectories (0-4 years of age) were identified using model-based clustering and categorized as "normal weight gain," "weight gain during infancy," "weight gain during childhood" and "persistent weight gain." MEASUREMENTS: Differences in DHEAS levels at age 7 between the four weight trajectories were analysed through analysis of covariance (ANCOVA), adjusted for birth weight (BW) and body mass index (BMI). RESULTS: In the crude analysis, compared with the "normal weight gain" trajectory (5.53 (95% CI: 5.10-5.98] µmol/L), DHEAS levels were significantly higher in children in the "persistent weight gain" (8.75 [95% CI: 7.23-10.49] µmol/L, p < .001] and in children in the "weight gain during infancy" trajectories (7.68 [95% CI: 6.22-9.49] µmol/L, p = .021] and marginally significantly higher in children in the "weight gain during childhood" trajectory (6.89 (95% CI: 5.98-8.00) µmol/L; p = .052). In BW- and BMI-adjusted model, a statistically significant difference in DHEAS levels was found between the "persistent weight gain" (7.93 [95% CI: 6.43-9.86] µmol/L) and the "normal weight gain" trajectories ([5.75 [95% CI: 5.32-6.23] µmol/L; p = .039). CONCLUSION: Higher DHEAS levels are found in 7-year-old children following a trajectory of persistent weight gain from 0 to 4 years, independently of their BW or current BMI, highlighting the impact of exposure to overweight in the first years of life on prepubertal adrenal androgen production.