A 1997 investigation published by ...

A 1997 investigation published by the Pediatric Research in Office Settings (PROS) l a joint committee of the Lawson Wilkins Pediatric Endocrine Society to state that pubertal findings in black girls six years and older and in white girls seven years and older were normal. The age revision defining precocious puberty ensueed from observations that girls in the United States were reaching puberty at a younger age than was previously considered normal. Midyett and colleagues hypothesize that the recent guidelines, if followed, will lead to a significant underdiagnosis of endocrine conditions.

The authors performed a retrospective medical record review to determine the bulk to which girls six to eight years of age who were referr to the pediatric endocrinology clinic had endocrine pathology, and whether they had authentic precocious puberty (characterized by sum of two units signs of puberty) or entirely isolated premature thelarche or adrenarche. They also investigated whether the girls without pathology were more likely to be obese.

The authors reviewed 1570 outpatient visits to their pediatric endocrinology clinic by dint of white girls seven to eight years of age and black girls six to eight years of age. Of the 663 patients making these visits, 223 had been referr solely to be evaluated for precocious puberty. Statistical analysis was performed to compare differences in height, weight, and bone age between girls with pair signs of puberty versus single in kind and to compare pathology between lean and obese girls.

Of the 223 subject of attention patients, 105 (47 percent) had pair signs of puberty, 83 (37 percent) had pubic hair alone, and 24 (11 percent) had breast progression in a continuously ascending gradation alone. The remaining 11 girls (5 percent) had no actual pubertal findings. Of the 212 patients originate to have signs of puberty, 95 (45 percent) were obese. Although the majority of girls were diagnosed with idiopathic pubertal exhibition 26 girls had additional endocrine diagnoses, among them neurofibromatosis, germination hormone deficiency, McCune-Albright syndrome, hypothyroidism, congenital adrenal hyperplasia, pituitary microadenoma, and hyperinsulinism.

Patients with pair signs of pubertal development had significantly greater weight z scores, greater height z scores, higher material substance mass index, and more advanced bone age than girls with alone one sign of puberty. Although 45 percent of the total patients were obese, 81 percent of the girls with a diagnosis of additional endocrine conditions were obese.

Pathologic endocrine conditions were at hand in a subset of referr patients who would have been defined as normal according to the PROS study. Overall, 123 percent of the patients six to eight years of age manifested pathologic explanations for their sexual precocity. In addition, a sizable proportion of patients instanted with advanced bone age, which signified los of adult height potential. Adding to possible bear upons the authors cite studies suggesting that premature adrenarche may be a marker for hyperinsulinism. They also question whether the passing from hand to hand onset of puberty is that a great deal earlier than it has been in the past. They did not find any statistically significant differences in the incidence of truthful precocious puberty between black and white girls. Moreover, obesity was not associated with a decreased rate of pathologic findings.

The authors judge that all girls younger than eight years with brace signs of puberty should be referr for endocrine evaluation. Girls younger than eight years with common sign of puberty should, at a minimum, have a bone age evaluation.

CAROLINE WELLBERY, MD

Midyett LK et al. Are pubertal changes in girls before age 8 benign? Pediatrics January 2003;111:47-51

COPYRIGHT 2003 American Academy of Family Physicians

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