Assessing Psychiatric Evaluations in Premature Thelarche and Idiopathic Central Precocious Puberty Cases: Exploring Depression, Anxiety, Quality of Life, and Coping Challenges.

BACKGROUND: The physical and hormonal changes associated with central precocious puberty (CPP) and premature thelarche (PT) can be a significant source of stress for young girls, who may not be developmentally prepared to understand these changes. This study aims to investigate the presence of psychiatric disorders, assess depression, anxiety, coping difficulties, and the quality of life in girls diagnosed with PT, and compare them with idiopathic CPP (ICPP). METHOD: A total of 50 participants aged between 6-9 years (PT=33, ICPP=17) between July 2023 and December 2023 were included in the study. Both groups were evaluated by pediatric psychiatrists at a median of four months after diagnosis with ICPP or PT. RESULTS: The PT group (n=33) had a mean age of 7.81 ± 0.76 years, while the ICPP group (n=17) had a mean age of 8.15 ± 0.35 years (P=0.091). In the PT group, 90.9% were at Tanner stage 2 and 9.1% were at Tanner stage 3 of pubertal development. In the ICPP group, 35.2% were at Tanner stage 2, 58.8% were at Tanner stage 3, and 5.8% were at Tanner stage 4. As expected, compared to the PT group, the ICPP group had taller heights, higher body weights, higher basal and stimulated luteinizing hormone (LH) levels, and elevated follicle-stimulating hormone (FSH) and estradiol (E2) levels (p<0.05). The total Revised Child Anxiety and Depression Scale (RCADS) score was higher in the PT group compared to the ICPP group (P=0.003). The physical Pediatric Quality of Life (PedsQL) score, psychosocial PedsQL score, and total PedsQL scores were all significantly lower in the PT group (P=0.034, P=0.016, P=0.019, respectively). The total Strengths and Difficulties Questionnaire (SDQ) score, used to evaluate difficulties in coping with challenges, was statistically similar in both groups (P=0.063). Subjects with higher anxiety and depression scores had lower quality of life (P<0.001; R=-0.639). There was also a statistically significant positive correlation between RCADS scores and SDQ scores (P<0.001; R=0.648). We did not find a significant correlation between RCADS scores and hormonal profiles or age. CONCLUSION: Despite the hypothalamic-pituitary-gonadal axis not being active, we believe that PT cases may experience psychological impacts due to body changes. While PT cases may not necessitate medical intervention from an endocrinological perspective, addressing their psychological needs can contribute to a healthier overall process for these individuals. The study's findings highlight the need for healthcare providers to monitor the psychological status of PT patients alongside their physical health. Larger-scale studies including control groups are needed to clearly evaluate the relationship between body changes and psychological symptoms.

Review of the Literature on Current Changes in the Timing of Pubertal Development and the Incomplete Forms of Early Puberty.

Puberty is a sensitive period of life characterized by the appearance of secondary sex characteristics which leads to a complete sexual maturation. It physiologically starts between the age of 8 and 13 years in girls and 9 and 14 years in boys. In the last two decades, several studies have showed that start of puberty has moved up to younger ages by 12-18 months, and some of the hypotheses trying to explain this change include the role of nutritional status and obesity and the influence of extrinsic factors such as exposure to endocrine-disrupting chemicals (EDCs), as well. The hypothalamic-hypophysis-gonadal axis develops during embryogenesis, and except for a period of activation immediately after birth, remains suppressed until the onset of pubertal development. At the beginning of puberty, the pulse generator is reactivated, probably due to progressive stimulatory influences on GnRH neurons from glial signals and neurotrasmitters. Kisspeptin and its receptor play a fundamental role in this phase. Premature Pubarche/Adrenarche, Premature Thelarche, and Premature Menarche are incomplete forms of precocious pubertal development that have their origin in endocrine mechanisms that only recently have started to be understood. It is important to distinguish these forms from the complete ones in order to reassure patients and parents about the non-evolution of pubertal progression and avoid non-useful treatments with analogous LHRH.

Menstrual-like vaginal bleeding in prepubertal girls: an unexplained condition.

Unexplained menstrual-like cyclic vaginal bleeding, lasting for several days and without any uterine and vaginal anomaly, is a rare condition in prepubertal girls. Only small series (containing four to eleven cases) have been described in literature. We report our in nine girls presenting with vaginal bleeding without any abnormality at gynaecological, hormonal and echographic examination.

Pubertad en adolescentes de áreas rurales y urbanas / Puberty in adolescent of rural and urban areas

Introducción: los factores genéticos determinan un crecimiento potencial, pero el medio ambiente, inhibe o acelera su expresión. Objetivo: determinar el comportamiento según procedencia urbana o rural, de variables relacionadas con el desarrollo puberal: telarquia, pubarquia, menarquia...

Introduction: the genetic factors determine a potential growth, but the environment inhibits and to speed up its expression. Objective: to determine the behavior according the urban or rural origin of the variables related to the pubertal development: telarche, pubarche and menarche. Methods: a correlation and descriptive study was conducted in urban and rural adolescents from the Holguín province...

Telarquia prematura en lactantes y preescolares: efecto de la dieta / Premature thelarche in infants and preschooler children: effect of the diet

Evaluar el efecto de las recomendaciones dietéticas en la regresión de la telarquia prematura en lactantes y preescolares (entre 3 meses y 5 años y 11 meses de edad). Se estudiaron 80 pacientes con diagnóstico de telarquia prematura divididas en: grupo A de 31 pacientes (con dieta exenta de productos avícolas, tubérculos y soya) y grupo B de 41 pacientes (sin dieta). Servicio de Ginecología Infantil y Juvenil. Hospital de Niños "Dr. JM de los Ríos". Caracas. No hubo diferencia estadísticamente significativa en la edad de las pacientes: grupos A y B respectivamente (31,56 ± 22,40 meses vs. 43,44 ± 26,47 meses; P = 0,09). No se obtuvo variación significativa entre los grupos con respecto a la longitud del útero, (25,32 ± 5,09 mm vs. 28,20 ± 6,69 mm; P = 0,09) y al volumen ovárico derecho (0,52 ± 0,33 cm³ vs. 0,79 ± 0,69 cm³, P = 0,09). Se encontró diferencia estadísticamente significativa en el volumen ovárico izquierdo (0,45 ± 0,29 cm³ vs. 0,91 ± 1,40 cm³; P = 0,01). Se encontró aumento en los niveles de FSH para la edad de las pacientes (3,27 ± 2,29 mUI/mL vs. 2,88 ± 1,74 mUI/mL; P = 0,50). Los niveles de LH se encontraron dentro de límites normales (0,50 ± 0,81 mUI/mL vs. 0,51 ± 0,57 mUI/mL; P = 0,05). Las cifras de estradiol resultaron ligeramente elevadas (16,60 ± 12,12 pg/mL vs. 16,44 ± 8,79 pg/mL P = 0,95). El tiempo de regresión fue menor en el grupo B: 16 ± 6,19 meses vs. 10,75 ± 1,75 meses; (P = 0,01). La dieta de restricción de productos avícolas, tubérculos y soya no resultó de utilidad en la regresión de la telarquia prematura en las pacientes incluidas en este estudio

To evaluate the effect of dietary restriction in the regression of premature thelarche in infants (3 months to 2 years old) and preschooler children (2 to 5 years and 11 months old). 80 patients with diagnostic of premature thelarche divided into: group A with 31 patients (with diet exempt of avian products, tubercles and soybean) and group B with 41 patients (without diet). Servicio de Ginecologia Infantil y Juvenil. Hospital de Niños "Dr. JM de los Rios". Caracas. There was no significative statistical difference in age of patients: groups A and B respectively (31.56 ± 22.40 months vs. 43.44 ± 26.47 months; P = 0.09). There was no significative variation between groups in uterus length (25.32 ± 5.09 mm vs. 28.20 ± 6.69 mm; P = 0.09) and right ovarian volume (0.52 ± 0.33 cm³ vs. 0.79 ± 0.69 cm³, P = 0,09). There was a significative statistical difference in left ovarian volume (0.45 ± 0.29 cm³ vs. 0.91 ± 1.40 cm³; P = 0.11). An increase of FSH levels for age of patients was found (3.27 ± 2.29 mUI/mL vs. 2.88 ± 1.74 mUI/mL; P = 0.50). LH levels were within normal limits (0.50 ± 0.81 mUI/mL vs. 0.51 ± 0.57 mUI/mL; P = 0.96). Estradiol values resulted lightly increased (16.60 ± 12.12 pg/mL vs. 16.44 ± 8.79 pg/mL P = 0.95). The regression time was shorter in the group B: 16 ± 6.19 months vs. 10.75 ± 1.75 months; (P = 0.01). The diet with restriction of avian products, tubercles and soybean was no useful in the regression of premature thelarche in the patients included in this study

Estado nutricional en la telarquia y menarquia de adolescentes chilenas indígenas y no indígenas / Nutritional status in telarche and menarche in indigenous and non indigenous chilean adolescents

Se ha señalado que existiría un efecto compensatorio de la desnutrición crónica que induce al exceso de peso y esto seria más evidente en poblaciones indígenas. El objetivo de este trabajo fue establecer la asociación entre etnia indígena (mapuche) y composición corporal en telarquia y menarquia de indígenas y no indígenas. Mediante un diseño transversal, que se inició con un tamizaje de 10.192 niñas de 168 escuelas de la región de la Araucanía en Chile, para identificar 230 adolescentes en telarquia (estadio II de desarrollo de la glandula mamaria): 112 indígenas y 118 no indígenas y 239 en menarquia: 113 indígenas y 126 no indígenas, a quienes se evaluó el índice de masa corporal (IMC), circunferencia de cintura (CC), masa magra (MM) y grasa (MG). El IMC, CC y MM fueron mayores en indígenas en telarquia (p<0,001). En menarquia las diferencias disminuyeron alcanzando valores mayores en indígenas sólo en IMC y MG (p=0,04 y 0,02). Mediante regresión lineal, se observó que pertenecer a la etnia mapuche aumentó el IMC en 0,37 puntajes z, 95 por ciento intervalo de confianza (IC): 0,17-0,58 en telarquia y en 0,44 puntajes z (IC: 0,18-0,70) en menarquia. El ser mapuche se asoció a tener mayor CC, 3,33 cm (IC: 1,67-4,99) en telarquia y 3,17, (IC: 0,73 -5,60) en menarquia, esta procedencia se asocia también a mayor porcentaje de masa magra en telarquia, 1,3 (IC: 0,11-2,43) y mayor masa grasa en menarquia: 2,4 (IC: 1,02- 3,77). Los indicadores de composición corporal en adolescentes indígenas son preocupantes y sugieren que existan programas de fomento de estilos de vida saludable, aprovechando recursos existentes.

A compensatory effect of chronic malnutrition that influences excess of weight has been reported. This effect would be more evident in indigenous populations. The aim of this study was to find out the association between ethnic group (mapuche) and body composition in the telarche and menarche of indigenous and non indigenous adolescents. This was a cross sectional design. At the beginning, a screening of 10,121 girls from 168 schools in the Araucania Region, Chile was done. 230 adolescent in telarche (grade II of the development of the mammary gland) :112 indigenous and 118 non indigenous and 239 in menarche (113 indigenous and 126 non indigenous) were identified. Body mass index (BMI), waist circumference (WC), lean mass (LM) and fat mass (FM) were evaluated. BMI, WC and LM were higher in the indigenous adolescent in telarche. For those with menarche, the differences decreased, reaching with higher values for indigenous girls only in BMI and FM (p=0,04 and 0,02, respectively). Belonging to the indigenous group increased the BMI in 0.37 z scores in telarche (95 percent CI: 0,17-0,58) and 0,44 in menarche (95 percent CI:0,18-0,70). Being mapuche was also associated to higher WC: 3.33 cm (CI 1,67 - 4,99) in telarche and 3,17 cm (CI 0,73-5,60) in menarche and to higher lean mass only for those adolescents with telarche (1,3 CI: 0,11-2,43) and to fat mass only for those with menarche (2,4 CI: 1,02-3,77). The body composition indicators in indigenous adolescents are of concern and underscores the importance of programs to promote healthy lifestyles that take into account resources from the indigenous communities.