PEDIATRICS Vol. 99 No. 4 April 1997, pp. 505-512
Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network
Received Jan 23, 1996; accepted May 6, 1996.
,,
,
From the * Department of Maternal and Child Health, School
of Public Health and the Office of Chief Medical Examiner, University
of North Carolina, Chapel Hill, North Carolina; Pediatric Research
in Office Settings, Department of Research, American Academy of
Pediatrics, Elk Grove Village, Illinois; the § Department of
Pediatrics, University of Vermont College of Medicine, Burlington,
Vermont; the Department of Pediatrics, University of Puerto Rico
School of Medicine, San Juan, Puerto Rico; and the ¶ Department of
Biostatistics, School of Public Health, University of North Carolina,
Chapel Hill, North Carolina.
Objective. To determine the current prevalence and mean ages of onset of pubertal characteristics in young girls seen in pediatric practices in the United States.
Methods. A cross-sectional study was conducted by 225 clinicians in pediatric practices belonging to Pediatric Research in Office Settings, a practice-based research network. After standardized training in the assessment of pubertal maturation, practitioners rated the level of sexual maturation on girls 3 through 12 years who were undergoing complete physical examinations.
Results. Data were analyzed for 17 077 girls, of whom 9.6% were African-American and 90.4% white. At age 3, 3% of African-American girls and 1% of white girls showed breast and/or pubic hair development, with proportions increasing to 27.2% and 6.7%, respectively, at 7 years of age. At age 8, 48.3% of African-American girls and 14.7% of white girls had begun development. At every age for each characteristic, African-American girls were more advanced than white girls. The mean ages of onset of breast development for African-American and white girls were 8.87 years (SD, 1.93) and 9.96 years (SD, 1.82), respectively; and for pubic hair development, 8.78 years (SD, 2.00) and 10.51 years (SD, 1.67), respectively. Menses occurred at 12.16 years (SD, 1.21) in African-American girls and 12.88 years (SD, 1.20) of age in white girls.
Conclusions. These data suggest that girls seen in a sample of pediatric practices from across the United States are developing pubertal characteristics at younger ages than currently used norms. Practitioners may need to revise their criteria for referral of girls with precocious puberty, with attention to racial differences.
Key words: puberty, secondary sexual characteristics, growth and development, precocious puberty, menses, menstruation, adrenarche, thelarche.
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L. Ibanez, N. Potau, A. Ferrer, F. Rodriguez-Hierro, M. V. Marcos, and F. de Zegher Reduced Ovulation Rate in Adolescent Girls Born Small for Gestational Age J. Clin. Endocrinol. Metab., July 1, 2002; 87(7): 3391 - 3393. [Abstract] [Full Text] [PDF]
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L. Lazar, R. Kauli, A. Pertzelan, and M. Phillip Gonadotropin-Suppressive Therapy in Girls with Early and Fast Puberty Affects the Pace of Puberty but Not Total Pubertal Growth or Final Height J. Clin. Endocrinol. Metab., May 1, 2002; 87(5): 2090 - 2094. [Abstract] [Full Text] [PDF]
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I. L. Sedlmeyer and M. R. Palmert Delayed Puberty: Analysis of a Large Case Series from an Academic Center J. Clin. Endocrinol. Metab., April 1, 2002; 87(4): 1613 - 1620. [Abstract] [Full Text] [PDF]
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 G. F. Welch and D. M. Howard Gendered Voice in the Cathedral Choir Psychology of Music, April 1, 2002; 30(1): 102 - 120. [Abstract] [PDF]
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M. E. Silfen, A. M. Manibo, M. Ferin, D. J. McMahon, L. S. Levine, and S. E. Oberfield Elevated Free IGF-I Levels in Prepubertal Hispanic Girls with Premature Adrenarche: Relationship with Hyperandrogenism and Insulin Sensitivity J. Clin. Endocrinol. Metab., January 1, 2002; 87(1): 398 - 403. [Abstract] [Full Text] [PDF]
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 S.-T. T. Li, P. Lozano, D. C. Grossman, and E. Graham Hormone-Containing Hair Product Use in Prepubertal Children Arch Pediatr Adolesc Med, January 1, 2002; 156(1): 85 - 86. [Full Text] [PDF]
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R Viner Splitting hairs Arch. Dis. Child., January 1, 2002; 86(1): 8 - 10. [Full Text] [PDF]
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K. O. Klein, K. M. Barnes, J. V. Jones, P. P. Feuillan, and G. B. Cutler Jr. Increased Final Height in Precocious Puberty after Long-Term Treatment with LHRH Agonists: The National Institutes of Health Experience J. Clin. Endocrinol. Metab., October 1, 2001; 86(10): 4711 - 4716. [Abstract] [Full Text] [PDF]
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A. Papadimitriou Sex Differences in the Secular Changes in Pubertal Maturation Pediatrics, October 1, 2001; 108(4): e65 - 65. [Abstract] [Full Text] [PDF]
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E. O. Reiter and P. A. Lee Have the Onset and Tempo of Puberty Changed? Arch Pediatr Adolesc Med, September 1, 2001; 155(9): 988 - 989. [Full Text] [PDF]
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M. E. Herman-Giddens, L. Wang, and G. Koch Secondary Sexual Characteristics in Boys: Estimates From the National Health and Nutrition Examination Survey III, 1988-1994 Arch Pediatr Adolesc Med, September 1, 2001; 155(9): 1022 - 1028. [Abstract] [Full Text] [PDF]
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P. B. Kaplowitz, E. J. Slora, R. C. Wasserman, S. E. Pedlow, and M. E. Herman-Giddens Earlier Onset of Puberty in Girls: Relation to Increased Body Mass Index and Race Pediatrics, August 1, 2001; 108(2): 347 - 353. [Abstract] [Full Text] [PDF]
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M. R. Palmert and P. A. Boepple Variation in the Timing of Puberty: Clinical Spectrum and Genetic Investigation J. Clin. Endocrinol. Metab., June 1, 2001; 86(6): 2364 - 2368. [Abstract] [Full Text] [PDF]
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P. A. Lee, H. E. Kulin, and S. S. Guo Age of Puberty Among Girls and the Diagnosis of Precocious Puberty Pediatrics, June 1, 2001; 107(6): 1493 - 1493. [Full Text]
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M. Krstevska-Konstantinova, C. Charlier, M. Craen, M. Du Caju, C. Heinrichs, C. de Beaufort, G. Plomteux, and J.P. Bourguignon Sexual precocity after immigration from developing countries to Belgium: evidence of previous exposure to organochlorine pesticides Hum. Reprod., May 1, 2001; 16(5): 1020 - 1026. [Abstract] [Full Text] [PDF]
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L. S. Adair Size at Birth Predicts Age at Menarche Pediatrics, April 1, 2001; 107(4): e59 - e59. [Abstract] [Full Text] [PDF]
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M. E. Herman, G. PA, C. Bourdony, E. Slora, R. Wasserman;, D. P. Merke, A. Pathomvanich, and G. P. Chrousos Early Puberty: A Cautionary Tale Pediatrics, March 1, 2001; 107(3): 609 - 610. [Full Text]
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M. Sun, B. A Gower, A. A Bartolucci, G. R Hunter, R. Figueroa-Colon, and M. I Goran A longitudinal study of resting energy expenditure relative to body composition during puberty in African American and white children Am. J. Clinical Nutrition, February 1, 2001; 73(2): 308 - 315. [Abstract] [Full Text] [PDF]
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E. Terasawa and D. L. Fernandez Neurobiological Mechanisms of the Onset of Puberty in Primates Endocr. Rev., February 1, 2001; 22(1): 111 - 151. [Abstract] [Full Text]
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C. Phornphutkul, T. Okubo, K. Wu, Z. Harel, T. F. Tracy Jr., H. Pinar, S. Chen, P. A. Gruppuso, and G. Goodwin Aromatase P450 Expression in a Feminizing Adrenal Adenoma Presenting as Isosexual Precocious Puberty J. Clin. Endocrinol. Metab., February 1, 2001; 86(2): 649 - 652. [Abstract] [Full Text]
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 J. D. Kurtis, R. Mtalib, F. K. Onyango, and P. E. Duffy Human Resistance to Plasmodium falciparum Increases during Puberty and Is Predicted by Dehydroepiandrosterone Sulfate Levels Infect. Immun., January 1, 2001; 69(1): 123 - 128. [Abstract] [Full Text] [PDF]
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L. Ibáñez, J. DiMartino-Nardi, N. Potau, and P. Saenger Premature Adrenarche--Normal Variant or Forerunner of Adult Disease? Endocr. Rev., December 1, 2000; 21(6): 671 - 696. [Abstract] [Full Text]
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 G. M. Solomon and T. Schettler Environment and health: 6. Endocrine disruption and potential human health implications Can. Med. Assoc. J., November 1, 2000; 163(11): 1471 - 1476. [Full Text] [PDF]
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