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1.
Ital J Pediatr ; 47(1): 52, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673836

RESUMO

At the end of 2019, an emerging atypical pneumonia called COVID-19 (coronavirus disease 2019), caused by the novel coronavirus defined as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), was first reported. COVID-19 rapidly expanded leading to an epidemic in China, followed by a global pandemic during the year 2020. In few weeks Italy was assaulted by a severe health emergency, constraining the Italian government to put in place extraordinary restrictive measures, such as school closures and a strict lockdown extended to the entire country at the beginning of March 2020. Since the beginning of lockdown, the Endocrinology Unit of Bambino Gesù Children's Hospital has recorded a rapid increase of the outpatient consultations for suspected precocious or early puberty. We have now retrospectively analyzed all the consultations recorded in the database of our outpatient clinic from March to September 2020, and compared them with the consultations recorded in the same database from March to September 2019. Our preliminary data suggest a significant increase of precocious puberty cases in girls during the first period of COVID-19 pandemic. Further investigations in larger cohorts of children are needed in order to correlate the observed increase of precocious puberty with specific pathogenic factors.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis , Pandemias , Puberdade Precoce/epidemiologia , Quarentena , Criança , Feminino , Humanos , Itália/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária
2.
Ital J Pediatr ; 46(1): 165, 2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33148304

RESUMO

BACKGROUND: The timing of puberty in girls is occurring at an increasingly early age. While a positive family history is recognised as a predisposing factor for early or precocious puberty, the role of environmental factors is not fully understood. AIMS OF THE STUDY: To make a retrospective evaluation of the incidence of newly diagnosed central precocious puberty (CPP) and the rate of pubertal progression in previously diagnosed patients during and after the Italian lockdown for COVID-19, comparing data with corresponding data from the previous 5 years. To determine whether body mass index (BMI) and the use of electronic devices increased during lockdown in these patients. PATIENTS AND METHODS: The study included 49 females with CPP. We divided the patients into two groups: group 1, patients presenting a newly diagnosed CPP and group 2, patients with previously diagnosed slow progression CPP whose pubertal progression accelerated during or after lockdown. We collected auxological, clinical, endocrinological and radiological data which were compared with data from two corresponding control groups (patients followed by our Unit, March to July 2015-2019). Patients' families completed a questionnaire to assess differences in the use of electronic devices before and during lockdown. RESULTS: Thirty-seven patients presented newly diagnosed CPP (group 1) and 12, with previously diagnosed but untreated slow progression CPP presented an acceleration in the rate of pubertal progression (group 2). The number of new CPP diagnoses was significantly higher than the mean for the same period of the previous 5 years (p < 0.0005). There were no significant differences between patients in group 1 and control group 1 regarding time between appearance of B2 and CPP diagnosis, although group 1 patients had a significantly earlier chronological age at B2, a more advanced Tanner stage at diagnosis (p < 0.005), higher basal LH and E2 levels, higher LH peak after LHRH test (p < 0.05) and increased uterine length (p < 0.005) and ovarian volume (p < 0.0005). The number of patients with previously diagnosed CPP whose pubertal development accelerated was also statistically higher compared to controls (p < 0.0005). In this group, patients' basal LH (p < 0.05) and E2 levels (p < 0.0005) became more markedly elevated as did the LH peak after LHRH test (p < 0.05). These patients also showed a significantly accelerated progression rate as measured by the Tanner scale (p < 0.0005), uterine length (p < 0.005), and ovarian volume (p < 0.0005). In both group 1 and group 2, BMI increased significantly (p < 0.05) and patients' families reported an increased use of electronic devices (p < 0.0005). CONCLUSION: Our data show an increased incidence of newly diagnosed CPP and a faster rate of pubertal progression in patients with a previous diagnosis, during and after lockdown compared to previous years. We hypothesize that triggering environmental factors, such as the BMI and the use of electronic devices, were enhanced during lockdown, stressing their possible role in triggering/influencing puberty and its progression. However, more studies are needed to determine which factors were involved and how they interacted.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Puberdade Precoce/epidemiologia , Puberdade , Isolamento Social , Índice de Massa Corporal , Criança , Feminino , Humanos , Incidência , Itália/epidemiologia , Puberdade Precoce/diagnóstico , Estudos Retrospectivos
3.
Eur J Endocrinol ; 183(4): R107-R117, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32698138

RESUMO

Pubertal timing is regulated by the complex interplay of genetic, environmental, nutritional and epigenetic factors. Criteria for determining normal pubertal timing, and thus the definition of precocious puberty, have evolved based on published population studies. The significance of the genetic influence on pubertal timing is supported by familial pubertal timing and twin studies. In contrast to the many monogenic causes associated with hypogonadotropic hypogonadism, only four monogenic causes of central precocious puberty (CPP) have been described. Loss-of-function mutations in Makorin Ring Finger Protein 3(MKRN3), a maternally imprinted gene on chromosome 15 within the Prader-Willi syndrome locus, are the most common identified genetic cause of CPP. More recently, several mutations in a second maternally imprinted gene, Delta-like noncanonical Notch ligand 1 (DLK1), have also been associated with CPP. Polymorphisms in both genes have also been associated with the age of menarche in genome-wide association studies. Mutations in the genes encoding kisspeptin (KISS1) and its receptor (KISS1R), potent activators of GnRH secretion, have also been described in association with CPP, but remain rare monogenic causes. CPP has both short- and long-term health implications for children, highlighting the importance of understanding the mechanisms contributing to early puberty. Additionally, given the role of mutations in the imprinted genes MKRN3 and DLK1 in pubertal timing, other imprinted candidate genes should be considered for a role in puberty initiation.


Assuntos
Impressão Genômica/fisiologia , Puberdade Precoce/genética , Adolescente , Criança , Feminino , Estudo de Associação Genômica Ampla , Humanos , Kisspeptinas/genética , Masculino , Mutação , Puberdade/genética , Puberdade Precoce/epidemiologia , Receptores de Kisspeptina-1/genética
4.
J Clin Endocrinol Metab ; 105(3)2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31950145

RESUMO

CONTEXT: The clinical effects of classical 3ß-hydroxysteroid dehydrogenase 2 (3ßHSD2) deficiency are insufficiently defined due to a limited number of published cases. OBJECTIVE: To evaluate an integrated steroid metabolome and the short- and long-term clinical features of 3ßHSD2 deficiency. DESIGN: Multicenter, cross-sectional study. SETTING: Nine tertiary pediatric endocrinology clinics across Turkey. PATIENTS: Children with clinical diagnosis of 3ßHSD2 deficiency. MAIN OUTCOME MEASURES: Clinical manifestations, genotype-phenotype-metabolomic relations. A structured questionnaire was used to evaluate the data of patients with clinical 3ßHSD2 deficiency. Genetic analysis of HSD3B2 was performed using Sanger sequencing. Novel HSD3B2 mutations were studied in vitro. Nineteen plasma adrenal steroids were measured using LC-MS/MS. RESULTS: Eleven homozygous HSD3B2 mutations (6 novel) were identified in 31 children (19 male/12 female; mean age: 6.6 ±â€…5.1 yrs). The patients with homozygous pathogenic HSD3B2 missense variants of > 5% of wild type 3ßHSD2 activity in vitro had a non-salt-losing clinical phenotype. Ambiguous genitalia was an invariable feature of all genetic males, whereas only 1 of 12 female patients presented with virilized genitalia. Premature pubarche was observed in 78% of patients. In adolescence, menstrual irregularities and polycystic ovaries in females and adrenal rest tumors and gonadal failure in males were observed. CONCLUSIONS: Genetically-documented 3ßHSD2 deficiency includes salt-losing and non-salt-losing clinical phenotypes. Spared mineralocorticoid function and unvirilized genitalia in females may lead to misdiagnosis and underestimation of the frequency of 3ßHSD2 deficiency. High baseline 17OHPreg to cortisol ratio and low 11-oxyandrogen concentrations by LC-MS/MS unequivocally identifies patients with 3ßHSD2 deficiency.


Assuntos
Hiperplasia Suprarrenal Congênita , Progesterona Redutase/genética , Adolescente , Hiperplasia Suprarrenal Congênita/diagnóstico , Hiperplasia Suprarrenal Congênita/epidemiologia , Hiperplasia Suprarrenal Congênita/genética , Hiperplasia Suprarrenal Congênita/metabolismo , Animais , Células COS , Criança , Pré-Escolar , Chlorocebus aethiops , Estudos Transversais , Feminino , Estudos de Associação Genética , Testes Genéticos , Homozigoto , Humanos , Lactente , Masculino , Metaboloma , Mutação de Sentido Incorreto , Progesterona Redutase/deficiência , Puberdade Precoce/epidemiologia , Puberdade Precoce/genética , Puberdade Precoce/metabolismo , Turquia/epidemiologia
5.
Indian Pediatr ; 57(1): 63-64, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31937701

RESUMO

We retrospectively analyzed clinic records of 55 children (36 girls) with precocious puberty. Majority (34, 62%) had central precocious puberty, out of which 19 were idiopathic. Peripheral precocious puberty was seen in 14 children. Congenital adrenal hyperplasia was the commonest cause of peripheral precocious puberty (6, 42.8%).


Assuntos
Puberdade Precoce/epidemiologia , Puberdade Precoce/etiologia , Hiperplasia Suprarrenal Congênita/complicações , Hiperplasia Suprarrenal Congênita/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Índia , Masculino , Estudos Retrospectivos
6.
J Clin Endocrinol Metab ; 105(3)2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31702013

RESUMO

CONTEXT: Gonadotropin-releasing hormone analogues (GnRHa) and recombinant human growth hormone (rhGH) have been widely used to treat idiopathic central precocious puberty (CPP) or early and fast puberty (EFP). However, large-scale studies to evaluate the treatment effects on final adult height (FAH) are still lacking. OBJECTIVE: To assess the effects of long-term treatment for CPP/EFP on FAH and its main influencing factors. DESIGN AND SETTING: Retrospective, multicenter observational study from 1998 to 2017. PARTICIPANTS: Four hundred forty-eight Chinese girls with CPP/EFP received GnRHa and rhGH treatment (n = 118), GnRHa alone (n = 276), or no treatment (n = 54). MAIN OUTCOME MEASURES: FAH, target height (Tht), and predictive adult height (PAH). RESULTS: The height gain (FAH-PAH) was significantly different among the GnRHa and rhGH treatment, GnRHa alone, and no treatment groups (P < 0.05; 9.51 ± 0.53, 8.07 ± 0.37, and 6.44 ± 0.91 cm, respectively). The genetic height gain (FAH-Tht) was 4.0 ± 0.5 cm for the GnRHa + rhGH group and 2.0 ± 0.27 cm for the GnRHa group, while the control group reached their Tht. In addition, 5 critical parameters derived from PAH, bone age, and Tht, showed excellent performance in predicting which patients could gain ≥5 cm (FAH-PAH), and this was further validated using an independent study. CONCLUSIONS: The overall beneficial effect of GnRHa + rhGH or GnRHa on FAH was significant. The control group also reached their genetic target height. Clinicians are recommended to consider both the potential gains in height and the cost of medication.


Assuntos
Estatura/efeitos dos fármacos , Desenvolvimento Ósseo/efeitos dos fármacos , Hormônio Liberador de Gonadotropina/análogos & derivados , Hormônio do Crescimento Humano/administração & dosagem , Puberdade Precoce/tratamento farmacológico , Adolescente , Criança , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Puberdade Precoce/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
Arch Argent Pediatr ; 117(6): 388-391, 2019 12 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31758881

RESUMO

Hypothyroidism caused by Hashimoto's thyroiditis is the most common reason for thyroid dysfunction in children. Our objective was to analyze its impact on final stature in relation to height and pubertal stage at the time of diagnosis in children younger than 18 years with severe autoimmune hypothyroidism. Out of 79 patients, 78.5 % were girls. Those with goiter (56 %) had a better height at diagnosis than those without goiter (mean standard deviation score for height: 0.2 versus -2.42; p < 0.0001). Five girls (6.3 %) had precocious puberty. When considering the final stature of patients (n: 33), among those with short stature at the time of diagnosis, pubertal children had a significantly shorter final stature than prepubertal children (mean standard deviation score for height: -2.82 versus -1.52; p = 0.0311). The late diagnosis of severe hypothyroidism in pediatrics has a negative impact on final stature, especially in those who were pubertal patients at the time of diagnosis.


Assuntos
Estatura/fisiologia , Transtornos do Crescimento/etiologia , Doença de Hashimoto/complicações , Tireoidite Autoimune/complicações , Criança , Diagnóstico Tardio , Feminino , Bócio/epidemiologia , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/etiologia , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Puberdade Precoce/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Tireoidite Autoimune/diagnóstico , Tireoidite Autoimune/etiologia
8.
J Pediatr Endocrinol Metab ; 32(12): 1369-1375, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31605579

RESUMO

Background The standard treatment of central precocious puberty (CPP) is gonadotropin-releasing hormone analogues (GnRHa). It is a concern that children treated with GnRHa are at risk of developing obesity which could impair the treatment outcomes. This study aimed to investigate the effect of GnRHa on body mass index (BMI) standard deviation score (SDS), and the influence of BMI status on treatment outcomes in children with idiopathic CPP (iCPP). Methods A retrospective cohort study in children with iCPP who completed GnRHa treatment and had attained near final adult height (NFAH) was conducted. Children with a history of disease or drug ingestion which could affect their BMI were excluded. BMI, BMI SDS, height (Ht), Ht SDS, predicted adult height (PAH), and NFAH were compared at baseline, 1 and 2 years during treatment, and at NFAH according to the baseline BMI status; normal weight and overweight/obesity. Results Fifty-eight children with iCPP treated with GnRHa were enrolled. The BMI SDS was significantly increased at 1 and 2 years during treatment in the overweight/obese group and at 1 year during treatment in the normal-weight group. However, at NFAH (2 years after treatment discontinuation), the BMI SDS was not statistically different from baseline in both groups. Ht gain, change in Ht SDS and BMI SDS were not statistically different from the baseline in both groups. Conclusions GnRHa results in a transient increase in BMI SDS during treatment and returned to baseline after treatment cessation. The benefit of GnRHa treatment on final Ht improvement is similar between overweight/obese and normal-weight patients.


Assuntos
Estatura , Peso Corporal , Hormônio Liberador de Gonadotropina/administração & dosagem , Obesidade/fisiopatologia , Sobrepeso/fisiopatologia , Puberdade Precoce/tratamento farmacológico , Adulto , Estudos de Casos e Controles , Criança , Feminino , Hormônio Liberador de Gonadotropina/análogos & derivados , Humanos , Masculino , Prevalência , Puberdade Precoce/epidemiologia , Puberdade Precoce/patologia , Estudos Retrospectivos , Resultado do Tratamento
9.
Obesity (Silver Spring) ; 27(10): 1661-1670, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31479205

RESUMO

OBJECTIVE: The aim of this study was to investigate the relationship of BMI with subsequent statural growth among children born in the era of the obesity epidemic. METHODS: Among 18,271 children from Belarus (n = 16,781, born 1996 to 1997) and the United States (n = 1,490, born 1999 to 2002), multivariable linear and ordinal logistic regression was used to analyze associations of BMI z score from infancy to adolescence with subsequent standardized length and height velocity, standing height and its components (trunk and leg lengths), and pubertal timing. RESULTS: The prevalence of early adolescent obesity was 6.2% in Belarus and 12.8% in the United States. In both Belarusian and US children, higher BMI z scores in infancy and childhood were associated with faster length and height velocity in early life, while higher BMI z scores during middle childhood were associated with slower length and height velocity during adolescence. Associations with greater standing height and trunk length and earlier pubertal development in adolescence were stronger for BMI z scores at middle childhood than BMI z scores at birth or infancy. CONCLUSIONS: These findings in both Belarus and the United States support the role of higher BMI in accelerating linear growth in early life (taller stature and longer trunk length) but earlier pubertal development and slower linear growth during adolescence.


Assuntos
Desenvolvimento do Adolescente/fisiologia , Estatura/fisiologia , Índice de Massa Corporal , Desenvolvimento Infantil/fisiologia , Puberdade/fisiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Obesidade Pediátrica/epidemiologia , Gravidez , Prevalência , Puberdade Precoce/epidemiologia , República de Belarus/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
10.
Rev Epidemiol Sante Publique ; 67(6): 393-396, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31519350

RESUMO

BACKGROUND: Early menarche is associated with increased risks for several diseases such as cardiovascular diseases and breast cancer. This analysis aimed at generating evidence on a historical trend towards younger age at menarche among Lebanese girls. METHODS: A secondary analysis was conducted on data consolidated from three serial cross-sectional national surveys of women in Lebanon (2007, 2009 and 2012). A total of 6150 women were included in order to study the association between date of birth intervals and age at menarche. RESULTS: The mean age at menarche was 13.06 years, with a peak of the distribution at age 12. Women born before 1950 had a significantly higher mean age at menarche (13.21) compared to those born in 1970 and thereafter (12.95). A stratified analysis showed that women living outside the metropolitan Greater Beirut (GB) area were characterized by an older mean age at menarche (13.11) in all date of birth intervals compared to those in GB (12.89). However, age at menarche declined more significantly over the last two decades among women outside GB, compared to those living in GB. CONCLUSIONS: Epidemiological figures emerging from this study confirm that trends in Lebanon are in line with a global pattern of decreasing age at menarche. Urban-rural differences suggest that higher caloric content of diet and consequent early overweight, more evident in urban areas, are likely determinants of younger menarche. Evidence from this study calls for an urgent implementation of comprehensive multisectoral obesity prevention in children in Lebanon.


Assuntos
Menarca/fisiologia , Adolescente , Saúde do Adolescente/história , Saúde do Adolescente/tendências , Fatores Etários , Idade de Início , Criança , Estudos de Coortes , Estudos Transversais , Feminino , História do Século XX , História do Século XXI , Humanos , Líbano/epidemiologia , Menarca/etnologia , Sobrepeso/epidemiologia , Obesidade Pediátrica/epidemiologia , Puberdade Precoce/epidemiologia , Fatores Socioeconômicos
11.
Best Pract Res Clin Endocrinol Metab ; 33(3): 101300, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31401055

RESUMO

The onset of puberty strongly depends on organizational processes taking place during the fetal and early postnatal life. Therefore, exposure to environmental pollutants such as Endocrine disrupting chemicals (EDCs) during critical periods of development can result in delayed/advanced puberty and long-term reproductive consequences. Human evidence of altered pubertal timing after exposure to endocrine disrupting chemicals is equivocal. However, the age distribution of pubertal signs points to a skewed distribution towards earliness for initial pubertal stages and towards lateness for final pubertal stages. Such distortion of distribution is a recent phenomenon and suggests environmental influences including the possible role of nutrition, stress and endocrine disruptors. Rodent and ovine studies indicate a role of fetal and neonatal exposure to EDCs, along the concept of early origin of health and disease. Such effects involve neuroendocrine mechanisms at the level of the hypothalamus where homeostasis of reproduction is programmed and regulated but also peripheral effects at the level of the gonads or the mammary gland.


Assuntos
Disruptores Endócrinos/efeitos adversos , Puberdade/efeitos dos fármacos , Animais , Poluentes Ambientais/efeitos adversos , Feminino , Homeostase/efeitos dos fármacos , Humanos , Hipotálamo/efeitos dos fármacos , Masculino , Puberdade Precoce/epidemiologia
12.
J Clin Endocrinol Metab ; 104(12): 6101-6115, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31373627

RESUMO

CONTEXT: Data on hypothalamic-pituitary (HP) disorders in systematically evaluated childhood cancer survivors are limited. OBJECTIVE: To describe prevalence, risk factors, and associated adverse health outcomes of deficiencies in GH deficiency (GHD), TSH deficiency (TSHD), LH/FSH deficiency (LH/FSHD), and ACTH deficiency (ACTHD), and central precocious puberty (CPP). DESIGN: Retrospective with cross-sectional health outcomes analysis. SETTING: Established cohort; tertiary care center. PATIENTS: Participants (N = 3141; median age, 31.7 years) were followed for a median 24.1 years. MAIN OUTCOME MEASURE: Multivariable logistic regression was used to calculate ORs and 95% CIs for associations among HP disorders, tumor- and treatment-related risk factors, and health outcomes. RESULTS: The estimated prevalence was 40.2% for GHD, 11.1% for TSHD, 10.6% for LH/FSHD, 3.2% for ACTHD, and 0.9% for CPP among participants treated with HP radiotherapy (n = 1089), and 6.2% for GHD, and <1% for other HP disorders without HP radiotherapy. Clinical factors independently associated with HP disorders included HP radiotherapy (at any dose for GHD, TSHD, LH/FSHD, >30 Gy for ACTHD), alkylating agents (GHD, LH/FSHD), intrathecal chemotherapy (GHD), hydrocephalus with shunt placement (GHD, LH/FSHD), seizures (TSHD, ACTHD), and stroke (GHD, TSHD, LH/FSHD, ACTHD). Adverse health outcomes independently associated with HP disorders included short stature (GHD, TSHD), severe bone mineral density deficit (GHD, LH/FSHD), obesity (LH/FSHD), frailty (GHD), impaired physical health-related quality of life (TSHD), sexual dysfunction (LH/FSHD), impaired memory, and processing speed (GHD, TSHD). CONCLUSION: HP radiotherapy, central nervous system injury, and, to a lesser extent, chemotherapy are associated with HP disorders, which are associated with adverse health outcomes.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Doenças Hipotalâmicas , Doenças da Hipófise , Adolescente , Hormônio Adrenocorticotrópico/deficiência , Adulto , Idoso , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Neoplasias do Sistema Nervoso Central/epidemiologia , Neoplasias do Sistema Nervoso Central/radioterapia , Criança , Pré-Escolar , Estudos de Coortes , Irradiação Craniana/efeitos adversos , Irradiação Craniana/estatística & dados numéricos , Estudos Transversais , Feminino , Hormônio Foliculoestimulante/deficiência , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Hormônio do Crescimento Humano/deficiência , Humanos , Doenças Hipotalâmicas/diagnóstico , Doenças Hipotalâmicas/epidemiologia , Doenças Hipotalâmicas/etiologia , Hipotireoidismo/epidemiologia , Hipotireoidismo/etiologia , Lactente , Recém-Nascido , Hormônio Luteinizante/deficiência , Masculino , Pessoa de Meia-Idade , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/epidemiologia , Doenças da Hipófise/etiologia , Prevalência , Prognóstico , Puberdade Precoce/epidemiologia , Puberdade Precoce/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
13.
Horm Res Paediatr ; 91(3): 203-209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167216

RESUMO

OBJECTIVE: The aim of this work was to investigate the prevalence of premature thelarche (PT) in 18-month-old girls, and the incidence of clinically evaluated PT for girls aged 18-36 months. METHODS: In the prevalence substudy, a prospective population-based cohort of 3,140 girls born at Northern Älvsborg county hospital (NÄL) in Trollhättan, Sweden, was followed for 2 years. Girls with breast development at the 18-month health check were referred to one pediatric center in NÄL for evaluation. All girls with PT were included and followed for clinical outcome and 17ß-estradiol. The prospective incidence substudy covered 8 years in a 10-year period and included all girls aged 18-36 months born at NÄL who were clinically evaluated for PT. RESULTS: The prevalence of PT at 18 months in our cohort was 1.6/1,000. The 5 girls with PT no longer showed symptoms at the follow-up 3-6 months later. The incidence was 1.1/1,000 for girls aged 18-36 months and 1.0/1,000 for girls aged 18-30 months who were clinically evaluated for their PT. CONCLUSION: This is the first prospective population-based study of PT and it shows a prevalence of PT at age 18 months of 1.6/1,000. The incidence of clinically evaluated PT was 1.1/1,000. Our result is in line with other studies reporting the incidence of PT from medical records (0.4-40/1,000). The outcome of PT in our study, as in the other studies, is that the great majority of girls show only benign symptoms.


Assuntos
Puberdade Precoce/epidemiologia , Mama/crescimento & desenvolvimento , Mama/fisiopatologia , Criança , Pré-Escolar , Estradiol/sangue , Feminino , Seguimentos , Hospitais de Condado , Humanos , Incidência , Lactente , Prevalência , Estudos Prospectivos , Puberdade Precoce/sangue , Puberdade Precoce/fisiopatologia , Estudos Retrospectivos , Suécia/epidemiologia
14.
Eur J Endocrinol ; 181(2): 129-137, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31146258

RESUMO

Objective: Previous finding suggests that children growing up under chronic stress tend to experience earlier sexual maturity. The present study aims to examine polygenic risk by experience interaction in predicting pubertal timing, as well as provide insight regarding the relevance of two G × E paradigms. Design and methods: Data were analyzed from a 3-year prospective puberty cohort in Anhui Province, China. Breast Tanner stage and testicular volume (TV) of 997 children were annually assessed. The polygenic risk score (PRS) was computed based on 17 SNPs for early pubertal timing. Hair cortisol concentrations (HCC) were assessed in the first 3 cm hair segment as a biological marker of chronic stress. Results: Comparing with participants under moderate levels of stress as measured by HCC, the puberty-accelerating effects of chronic stress were only observed among girls with moderate (1.7 months earlier, P = 0.007) and low genetic susceptibility (2.2 months earlier, P < 0.001) and among boys with high genetic susceptibility (2.0 months earlier, P = 0.005). Polygenic differences (PRSs) in age at thelarche was most prominent in those with low levels of stress by HCC (9.06, 9.36 and 9.53 years for high, moderate and low PRS, respectively; F = 105.06, P < 0.0001), while polygenic differences in age at TV ≥4 mL was strongest in those under chronic stress (10.91, 11.06 and 11.17 years for high, moderate and low PRS, respectively; F = 100.48, P < 0.0001). Conclusion: Chronic stress predicts earlier age at pubertal onset in a sex-specific and genetic background-dependent manner. The bioecological G × E model for girls and diathesis stress model for boys in pubertal timing warrants further investigation.


Assuntos
Interação Gene-Ambiente , Herança Multifatorial/genética , Puberdade Precoce/genética , Puberdade Precoce/psicologia , Estresse Psicológico/genética , Estresse Psicológico/psicologia , Criança , China/epidemiologia , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Puberdade/fisiologia , Puberdade/psicologia , Puberdade Precoce/epidemiologia , Fatores de Risco , Maturidade Sexual/fisiologia , Estresse Psicológico/epidemiologia
15.
BMC Pediatr ; 19(1): 107, 2019 04 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975105

RESUMO

BACKGROUND: To investigate the prevalence and risk factors of premature thelarche (PT) in girls and gynecomastia (GM) in boys in Southern China. METHODS: We conducted a cross-sectional study of preschool children across 9 cities in Zhejiang province. A total of 6273 children in the age-group of 2-7 years were recruited from January 2014 to March 2015. Relevant information was collected from mothers through face-to-face interviews. Logistic regression models were used to examine the correlates of PT and GM. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported. RESULTS: The prevalence of PT among girls was 4.8% and that of GM among boys was 0.8%. One hundred girls were diagnosed with PT before the age of 2 years; 69 (69.0%) of these girls experienced spontaneous resolution of PT. Twenty-four boys were diagnosed with GM before the age of 2 years; 10 (41.7%) of these experienced spontaneous resolution of GM. Children borne of mothers with early onset of menarche and those belonging to high-income families were at a higher risk of premature breast development. Greater consumption of eggs was associated with premature breast development in early childhood. CONCLUSIONS: Socioeconomic status of family, early onset of menarche in mother, and consumption of eggs were strongly associated with premature breast development in early childhood.


Assuntos
Ginecomastia/epidemiologia , Menarca , Puberdade Precoce/epidemiologia , Medição de Risco/métodos , Distribuição por Idade , Criança , Pré-Escolar , China/epidemiologia , Estudos Transversais , Feminino , Ginecomastia/diagnóstico , Humanos , Masculino , Prevalência , Puberdade Precoce/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Classe Social
16.
Horm Mol Biol Clin Investig ; 38(1)2019 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-30851158

RESUMO

Background Subclinical hypothyroidism (SH) is more frequent in females than males, with a female to male ratio ranging from 1.5 to 5 in the general population. The aim of this study was to evaluate for the first time the association of reproductive factors, particularly age at menarche, with SH risk. Materials and methods In a cross-sectional study, reproductive factors such as age at menarche, at menopause and at first birth, lactation, parity, full-term pregnancies, reproductive years, use of oral contraceptives and hormonal replacement therapy, somatometric data and insulin resistance parameters were recorded in 72 consecutive female patients with SH and 72 healthy female controls matched on age (±5 years) and date of diagnosis (±1 month). Results SH cases exhibited significantly younger age at menarche than controls (12.6 ± 1.2 vs. 13.3 ± 0.8 years, respectively, p < 0.001). Cases presented later age at first pregnancy with a lower number of full-term pregnancies (p = 0.04). Early age at menarche was independently associated with SH risk, above and beyond thyroid autoimmunity, body mass index (BMI), hip circumference (HC), homeostatic model assessment of insulin resistance and alcohol consumption [odds ratio (OR): 0.22, 95% confidence interval (CI): 0.11-0.44; p < 0.001]. Conclusions It is possible that an interplay of early exposure to estrogens, as expressed by early menarche, and induction of thyroid autoimmunity may be associated with SH risk. More prospective studies shedding light on the role of estrogens in SH are required to confirm these findings.


Assuntos
Hipotireoidismo/epidemiologia , Menarca , Puberdade Precoce/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade
18.
J Pediatr ; 208: 221-228, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30857777

RESUMO

OBJECTIVES: To investigate the prevalence and incidence of central precocious puberty in Korea using claims data provided by the Health Insurance Review and Assessment Service in Korea as the population-based epidemiologic study. STUDY DESIGN: In this national registry-based, longitudinal, epidemiologic study, patients who were registered with an International Classifications of Diseases, Tenth Revision diagnosis of central precocious puberty (E22.8 according to International Classifications of Diseases, Tenth Revision) and treated with gonadotropin-releasing hormone agonist were included. We assessed the age- and sex-specific prevalence and incidence rates of central precocious puberty in Korea from 2008 to 2014. RESULTS: A total of 37 890 girls and 1220 boys were newly registered with a diagnosis of central precocious puberty from 2008 to 2014. The overall incidence of central precocious puberty during the study period was 122.8 per 100 000 persons (girls, 262.8; boys, 7.0). The overall prevalence of central precocious puberty during the study period was 193.2 per 100 000 persons (girls, 410.6; boys, 10.9). The incidence and prevalence of central precocious puberty steeply increased during the study period in both girls and boys. CONCLUSIONS: This epidemiologic study, based on a national registry that included Korean children, demonstrated that the incidence and prevalence rates of central precocious puberty were high and increased steeply during the study period. Further investigations to determine the underlying causes for this rapid increase in central precocious puberty are needed.


Assuntos
Puberdade Precoce/epidemiologia , Sistema de Registros , Fatores Etários , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Hormônio Liberador de Gonadotropina/agonistas , Humanos , Incidência , Seguro Saúde , Estudos Longitudinais , Masculino , Prevalência , República da Coreia/epidemiologia , Estudos Retrospectivos
19.
World J Pediatr ; 15(3): 297-305, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30783950

RESUMO

BACKGROUND: Internationally adopted children (IAC) can present growth impairment at arrival, which usually recovers over time. Moreover, a major prevalence of precocious puberty has been reported in this group. METHODS: All IAC referred to a tertiary level hospital in Italy from January 2016 to June 2017, underwent a standardized screening protocol and were prospectively enrolled in the study. The analyses of possible risk factors for growth impairment and precocious puberty were performed. RESULTS: Overall, 422 children were included (males 59.5%), with median age of 6.5 years (IQR 9.4-3.9), 29.9% adopted from Europe, 26.8% from Asia, 23.9% from Africa and 19.4% from Latin America. Children were in Italy from a median of 75 days (IQR 137.0-38.7). Stunting was observed in 12.9% of children, wasting in 4.3%, underweight in 12.9%. Precocious puberty was diagnosed in 2.2% of children. 17.1% IAC had diagnosis of special needs. Fetal alcohol spectrum disorders represented the 41.7% of children with special needs and 48.1% of Russian children. Independent predictive factors for stunting were age < 5 years, a diagnosis of special need and having been living in Italy for < 60 days since the arrival. CONCLUSION: Stunting among IAC is a frequent finding especially in children < 5 years and in those with special needs, independently from their geographical origin.


Assuntos
Criança Adotada , Transtornos do Crescimento/epidemiologia , Puberdade Precoce/epidemiologia , Criança , Feminino , Humanos , Itália/epidemiologia , Masculino , Estudos Prospectivos , Fatores de Risco
20.
BMC Res Notes ; 12(1): 61, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683149

RESUMO

OBJECTIVES: To determine the influence of sexual maturation status on adiposity indicators of children and adolescents. RESULTS: 2412 individuals participated, 1285 (47.4%) males and 1408 (52.6%) females. There was moderate to weak correlation between age and adiposity indicators for both sexes. By analyzing the relationship between age and body fat indexes adjusted for Sexual Maturation Status, several changes were observed, mainly in girls. Precocious maturation was associated with increased adiposity indicators in girls, whereas late maturation was associated with decreased adiposity indicators in both sexes. Precocious maturation was associated with increased adiposity indicators in girls, whereas late maturation was associated with decreased adiposity indicators in both sexes.


Assuntos
Adiposidade/fisiologia , Obesidade Pediátrica/epidemiologia , Puberdade Tardia/epidemiologia , Puberdade Precoce/epidemiologia , Maturidade Sexual/fisiologia , Adolescente , Fatores Etários , Brasil/epidemiologia , Criança , Comorbidade , Feminino , Humanos , Masculino
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