 |
|
 |
|
 |
 |
|
 |
 |
 |
 |
 |
 |
 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
From the Section of Endocrinology, Children’s Mercy Hospital, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
--> Objective. The Lawson Wilkins Pediatric Endocrine Society recently issued new recommendations for the age at which puberty should be considered precocious, lowering the prevailing standards from 8 years to 7 years for white girls and to 6 years for black girls. The new recommendations were based on a single epidemiologic study that focused on the conditions of premature thelarche and premature adrenarche (both characterized by a single sign of puberty). Although the data were available, the authors did not comment on the low incidence of true precocious puberty (characterized by breast and pubic hair development) in their population. The hypothesis for the present study is that the new recommendations lead to underdiagnosis of endocrine pathology
Methods. Using 29 International Classification of Diseases, Ninth Revision codes for diagnoses known to be associated with precocious puberty, we identified 1570 patient visits to our outpatient pediatric endocrinology clinic of white girls aged 7 to 8 and black girls aged 6 to 8 during a 5-year period
Results. Of the 1570 patient visits, 223 unique patients were identified as having been referred for the sole finding of precocious pubertal development. These 223 patients carried no other endocrine diagnoses. Eleven patients (4.9%) were found to have no true breast buds and no terminally differentiated pubic hair. A total of 105 (47.1%) of 223 patients were found to have 2 signs of puberty, consistent with true precocious puberty according to the conventional guidelines of precocity of 8 years in girls. Overall, 12.3% of patients also had diagnoses of other endocrine conditions that included congenital adrenal hyperplasia, McCune-Albright syndrome, growth hormone deficiency, hypothyroidism, hyperinsulinism, pituitary adenoma, and neurofibromatosis. A total of 35.2% of girls with true precocious puberty exhibited bone ages >3 standard deviations above the mean, indicating markedly diminished growth potential
Conclusions. We conclude that signs of puberty in 6- to 8-year-old girls should not be considered normal or benign. Implementation of the new guidelines for the evaluation of puberty will result in failure to identify conditions that respond to early intervention.
Key Words: precocious puberty • premature thelarche • premature adrenarche • body mass index • polycystic ovary syndrome • hyperinsulinism
Abbreviations: PROS, Pediatric Research in Office Settings • BMI, body mass index • SD, standard deviation
This article has been cited by other articles:
 |
|
 |
|
  J.-C. Carel and J. Leger Precocious Puberty N. Engl. J. Med., May 29, 2008; 358(22): 2366 - 2377. [Full Text] [PDF]
|
|
|
|
 |
|
 L. S. Nield, N. Cakan, and D. Kamat A Practical Approach to Precocious Puberty Clinical Pediatrics, May 1, 2007; 46(4): 299 - 306. [PDF]
|
|
|
|
 |
|
 R. L. Rosenfield Identifying Children at Risk for Polycystic Ovary Syndrome J. Clin. Endocrinol. Metab., March 1, 2007; 92(3): 787 - 796. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Muir Precocious Puberty Pediatr. Rev., October 1, 2006; 27(10): 373 - 381. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Aksglaede, A. Juul, H. Leffers, N. E. Skakkebaek, and A.-M. Andersson The sensitivity of the child to sex steroids: possible impact of exogenous estrogens Hum. Reprod. Update, July 1, 2006; 12(4): 341 - 349. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Teilmann, C. B. Pedersen, T. K. Jensen, N. E. Skakkebaek, and A. Juul Prevalence and Incidence of Precocious Pubertal Development in Denmark: An Epidemiologic Study Based on National Registries Pediatrics, December 1, 2005; 116(6): 1323 - 1328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. de Vries and M. Phillip Children Referred for Signs of Early Puberty Warrant Endocrine Evaluation and Follow-Up J. Clin. Endocrinol. Metab., January 1, 2005; 90(1): 593 - 593. [Full Text] [PDF]
|
|
|
|
|
|
P. Kaplowitz, M. Herman-Giddens, and R. Wasserman Navigating Recent Articles on Girls' Puberty: Where Should Our Patients Go for Evaluation?: In Reply Pediatrics, January 1, 2005; 115(1): 195 - 195. [Full Text] [PDF]
|
|
|
|
|
|
J. D. Jacobson, L. K. Midyett, and W. V. Moore Navigating Recent Articles on Girls' Puberty: Where Should Our Patients Go for Evaluation? Pediatrics, January 1, 2005; 115(1): 194 - 195. [Full Text] [PDF]
|
|
|
|
|
|
P. Kaplowitz Clinical Characteristics of 104 Children Referred for Evaluation of Precocious Puberty J. Clin. Endocrinol. Metab., August 1, 2004; 89(8): 3644 - 3650. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Herman-Giddens, P. B. Kaplowitz, and R. Wasserman Navigating the Recent Articles on Girls' Puberty in Pediatrics: What Do We Know and Where Do We Go from Here? Pediatrics, April 1, 2004; 113(4): 911 - 917. [Full Text] [PDF]
|
|
|
|
|
|
J.-C. Carel, N. Lahlou, M. Roger, and J. L. Chaussain Precocious puberty and statural growth Hum. Reprod. Update, March 1, 2004; 10(2): 135 - 147. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A.-S. Parent, G. Teilmann, A. Juul, N. E. Skakkebaek, J. Toppari, and J.-P. Bourguignon The Timing of Normal Puberty and the Age Limits of Sexual Precocity: Variations around the World, Secular Trends, and Changes after Migration Endocr. Rev., October 1, 2003; 24(5): 668 - 693. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Rose Timing of Puberty in US Girls AAP Grand Rounds, April 1, 2003; 9(4): 39 - 39. [Full Text] [PDF]
|
|
|
|
 |
|
 Onset of Puberty in Young Girls: When to Worry Journal Watch (General), January 28, 2003; 2003(128): 8 - 8. [Full Text]
|
|
Read all P3Rs
 |
||
|
||
Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2003 American Academy of Pediatrics. All rights reserved. |
||
|
||
