Evaluation and Referral of Children With Signs of Early Puberty.

Concerns about possible early pubertal development are a common cause for referral to pediatric medical subspecialists. Several recent studies have suggested that onset of breast and/or pubic hair development may be occurring earlier than in the past. Although there is a chance of finding pathology in girls with signs of puberty before 8 years of age and in boys before 9 years of age, the vast majority of these children with signs of apparent puberty have variations of normal growth and physical development and do not require laboratory testing, bone age radiographs, or intervention. The most common of these signs of early puberty are premature adrenarche (early onset of pubic hair and/or body odor), premature thelarche (nonprogressive breast development, usually occurring before 2 years of age), and lipomastia, in which girls have apparent breast development which, on careful palpation, is determined to be adipose tissue. Indicators that the signs of sexual maturation may represent true, central precocious puberty include progressive breast development over a 4- to 6-month period of observation or progressive penis and testicular enlargement, especially if accompanied by rapid linear growth. Children exhibiting these true indicators of early puberty need prompt evaluation by the appropriate pediatric medical subspecialist. Therapy with a gonadotropin-releasing hormone agonist may be indicated, as discussed in this report.

Efficacy and safety of leuprolide acetate 3-month depot 11.25 milligrams or 30 milligrams for the treatment of central precocious puberty.

CONTEXT: GnRH agonist (GnRHa) monthly injections are frequently used in the treatment of central precocious puberty (CPP). The 3-month leuprolide depot 11.25- and 30-mg formulations are newly approved treatment options. OBJECTIVE: The aim of the study was to investigate the safety and efficacy of leuprolide acetate 3-month depot formulations for the treatment of CPP in children. DESIGN: This was a phase III, randomized, open-label, dose-ranging 6-month study. SETTING: Twenty-two U.S. medical centers (including Puerto Rico) participated. PATIENTS: Children diagnosed with CPP (n = 84), who were either treatment naive or previously treated with GnRHa, were recruited. Chronological age at onset of pubertal signs was less than 8 yr in girls and less than 9 yr in boys, and bone age was advanced over chronological age at least 1 yr. INTERVENTION: Leuprolide acetate depot (11.25 or 30 mg) was administered im every 3 months. MAIN OUTCOME MEASURES: Biochemical [peak-stimulated LH, estradiol (girls), and testosterone (boys)] and anthropometric (growth rate, bone age acceleration, pubertal progression) parameters and safety were assessed. RESULTS: Peak-stimulated LH was suppressed in the 11.25- and 30-mg dose groups in 78.4 and 95.2%, respectively, of children from months 2 through 6. There were nine treatment failures (peak-stimulated LH >4 IU/liter) in the 11.25-mg group and two in the 30-mg group. Basal sex steroid suppression, growth rates, pubertal progression, bone age advancement, and adverse events were similar with either dose. CONCLUSIONS: Treatment with leuprolide acetate 3-month depot formulations (11.25 and 30 mg) effectively suppressed the GnRH axis, was well tolerated, and may positively impact patient convenience and compliance.

Caregiver reports of provider recommended frequency of blood glucose monitoring and actual testing frequency for youth with type 1 diabetes.

AIMS: To identify demographic, family and clinical characteristics associated with provider recommended frequency of blood glucose monitoring (BGM), actual frequency of BGM, and concordance between these categories in youth with type 1 diabetes (T1D) as reported by child's caregiver. METHODS: Caregivers of 390 children 10-17 years were interviewed about their children's providers' recommendations for frequency of BGM and their child's frequency of performance of BGM. RESULTS: The majority (92%) of caregivers reported being told that their child should BGM ≥4 times per day and 78% reported their child checked that frequently. Caregivers of children who were younger, non-Hispanic White, from two-parent households, higher income households, and on insulin pumps were more likely to report being told by their provider to perform BGM ≥6 times per day and more likely to report that their child performed BGM ≥6 times per day. Younger children and those with private health insurance were more likely to adhere to reported recommendations. Children whose caregivers reported that their child met/exceeded their provider recommendations had lower A1c values than those who did not. CONCLUSIONS: These findings may help clinicians identify subgroups of youth at-risk for poor diabetes management and provide further education in order to improve outcomes.

Leuprolide acetate 1-month depot for central precocious puberty: hormonal suppression and recovery.

Methods. This prospective US multicenter trial of leuprolide acetate 1-month depot (7.5-15 mg) for central precocious puberty utilized an open-label treatment period, long-term follow-up, and adult callback. Forty-nine females <9 years old with Tanner breast stage ≥2 before 8 years and 6 males <10 years old with Tanner genital stage ≥2 before 9 years with stimulated LH ≥10 IU/L and bone age advance ≥1 year were enrolled. Results. Subjects were treated for 3.9 ± 2.0 years. Mean peak GnRH-stimulated LH and FSH were prepubertal after the first dose and remained suppressed throughout treatment. During treatment, mean estradiol decreased to the limit of detection and mean testosterone decreased but remained above prepubertal norms. During posttreatment follow-up (3.5 ± 2.2 years), all patients achieved a pubertal hormonal response within 1 year and menses were reported in all females ≥12 years old. No impairment of reproductive function was observed at adulthood (mean age: 24.8 years).

Family history of diabetes, autoimmunity, and risk factors for cardiovascular disease among children with diabetes in the SEARCH for Diabetes in Youth Study.

BACKGROUND: While type 1 diabetes and type 2 diabetes (T2D) are considered etiologically distinct, mixed features of autoimmunity and insulin resistance are increasingly common. We explored a familial contribution to this admixture by evaluating diabetes family history (FH) and its relationship to diabetes type, ethnicity, age at diagnosis, and cardiovascular risk factors in SEARCH for Diabetes in Youth Study participants. METHODS: Diabetes FH was assessed by questionnaire, with FH categories defined by relative's(s') age at diagnosis as follows: <25 (early FH), >/=25 (later FH), and both <25 and >/=25 (mixed FH). Diabetes type was classified based on a biochemical algorithm using diabetes autoantibodies and fasting C-peptide (FCP). RESULTS: A positive FH was common in all diabetes types, particularly T2D (83%). Minorities were more likely to have a positive FH than non-Hispanic Whites [odds ratio (OR) 1.96, 95% confidence interval (CI) 1.69-2.27]. The likelihood of having an early FH decreased with age at diagnosis (OR 0.95, 95% CI 0.93-0.98), and the likelihood of having a later/mixed or any positive FH increased with age (OR 1.03, 95% CI 1.01-1.04; OR 1.03, 95% CI 1.02-1.05, respectively). Higher FCP concentrations and less desirable values for almost all cardiovascular risk factors were associated with a later/mixed FH. The association between a later/mixed FH and FCP, body mass index, waist circumference, triglycerides, and high-density lipoprotein remained significant in a subgroup of autoimmune participants. CONCLUSIONS: Later FH confers cardiovascular risk factors in diabetic youth, including those youth with islet cell autoimmunity. This characterization of diabetes FH may provide a better understanding of familial contributors to diabetes.

Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth.

OBJECTIVE: We sought to assess the long-term trends in the incidence of type 1 diabetes among non-Hispanic white and Hispanic youth aged 0-17 years from Colorado using data from the Colorado IDDM Study Registry (1978-1988) and SEARCH for Diabetes in Youth (2002-2004). RESEARCH DESIGN AND METHODS: Cases of diabetes were ascertained through physician reporting and hospital databases. Type 1 diabetes was defined as use of insulin within 2 weeks from diagnosis. Completeness of ascertainment was estimated as 97%. Annual average incidence rates (per 100,000/year) and 95% CIs for the time periods were computed. Trends in incidence were assessed by Poisson regression. RESULTS: The incidence of type 1 diabetes was 14.8 (95% CI 14.0-15.6) in 1978-1988 and 23.9 (22.2-25.6) in 2002-2004 for the state of Colorado (P < 0.0001). From 1978 to 2004, the incidence of type 1 diabetes increased by 2.3% (1.6-3.1) per year (P < 0.0001). The increase in incidence was significant for both non-Hispanic white (2.7% [95% CI 1.9-3.6] per year, P < 0.0001) and Hispanic youth (1.6% [0.2-3.1] per year, P = 0.013). CONCLUSIONS: The incidence of type 1 diabetes has increased 1.6-fold among Colorado youth from 1978-1988 to 2002-2004, and both non-Hispanic white and Hispanic youth are affected by this trend.

Prepubertal gynecomastia linked to lavender and tea tree oils.

Most cases of male prepubertal gynecomastia are classified as idiopathic. We investigated possible causes of gynecomastia in three prepubertal boys who were otherwise healthy and had normal serum concentrations of endogenous steroids. In all three boys, gynecomastia coincided with the topical application of products that contained lavender and tea tree oils. Gynecomastia resolved in each patient shortly after the use of products containing these oils was discontinued. Furthermore, studies in human cell lines indicated that the two oils had estrogenic and antiandrogenic activities. We conclude that repeated topical exposure to lavender and tea tree oils probably caused prepubertal gynecomastia in these boys.

Congenital hypothyroidism and the second newborn metabolic screening in Colorado, USA.

OBJECTIVE: To evaluate the effectiveness of a second newborn screening for congenital hypothyroidism (CH). METHODS: All infants born in Colorado, USA, from July 1996 through June 2004 had a total thyroxine measured with secondary thyroid stimulating hormone determination. RESULTS: The number of first and second newborn screens completed was 494,324 and 471,877, respectively. The first screen identified 185 cases of CH (incidence of 1:2,703). The second screen identified an additional 42 cases. Overall, the incidence based on both the first and second screenings was 1:2,174. The false negative rate for the first screen was 15.6%. In the absence of a second screen, one infant with CH out of every 11,111 babies screened would have been missed. The addition of the second screen increased the cost-per-case identified from dollars 6,108 to dollars 9,730. CONCLUSIONS: With only one newborn screen for CH, the number of missed cases is significant and higher than previously reported.