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PubMed1993

Usefulness of ovarian volume and cysts in female isosexual precocious puberty.

The real-time pelvic sonograms of 32 girls under 8 years old with true isosexual precocity (23 cases), pseudosexual precocity (four cases), premature adrenarche (four cases), and an undetermined problem (one case) were evaluated retrospectively for ovarian volume and presence and size of cysts. Sonographic findings were compared to those of 181 age-matched controls to determine the best sonographic indicator of precocious puberty. Ovarian volume was 4.6 cm3 in girls with true isosexual precocity, 4.1 cm3 in girls with pseudosexual precocity, and less than 1 cm3 in the other patients as well as in the control population. Ovarian enlargement was bilateral in true precocity and unilateral in pseudosexual precocity. Of the 181 subjects in the control group, 96 (53%) had ovarian cysts, almost all of which were small (less than 9 mm in diameter). Ovarian cysts occurred in 22 of 32 patients (69%) with precocity. The cysts generally were smaller than 9 mm in true isosexual precocity and larger than 9 mm in pseudosexual precocity. In conclusion, small ovarian cysts are not specific to precocious puberty and its various subtypes. Bilateral ovarian enlargement appears to be a reliable indicator of true isosexual puberty, whereas unilateral ovarian enlargement in combination with macrocysts is suggestive of pseudosexual precocity.

Anthropometry↗
PubMed1999

[Follow-up study on effects of height velocity and puberty onset on biochemical markers of bone turnover].

In order to clarify the factors which affect bone metabolism at a young age, we investigated the relationships among the change of biochemical markers of bone turnover, the height velocity (HV) and puberty onset in healthy Japanese children. One hundred and twelve children (61 boys and 51 girls) were recruited at the fourth grade level in the elementary school (9 years old) and followed for 6 years. Serum bone specific alkaline phosphatase (B-ALP), serum tartrate-resistant acid phosphatase (TR-ACP), urine hydroxyproline (Hyp) and urine calcium (Ca) were measured as the biochemical markers of bone turnover. Bone mineral density of calcaneus was also measured by ultrasound method at the first grade (12 years old) and the third grade (14 years old) of junior high school. Heights and weights of all subjects were measured every April and the HV were calculated between each year. Puberty onset was defined as the time when pubic hair appeared in boys and as the time when menarche started in girls by self-administered questionnaire. All the biochemical markers of bone metabolism except for urine Ca had a significant positive relationship with HV. The values of the markers were highest of the time when the HV was maximum. In girls, the values of the biochemical markers remained high before menarche and then decreased significantly within three years after menarche, suggesting that bone turnover changed rapidly from high turnover type to low turnover type after menarche. On the other hand, in boys, high turnover type remained for a few years after puberty onset. Bone mineral density of calcaneus by ultrasound method increased significantly in boys between the two years in junior high school, but the increase was unclear except for broadband ultrasound attenuation (BUA) in girls in the same period.

Acid Phosphatase↗
PubMed1999

[The influence of IGF-1 on the biosynthesis of type I and III colagen during puberty].

OBJECTIVES: The influence of insulin-like growth factor I (IGF-I) on the biosynthesis of type I and III collagen during puberty was studied. MATERIAL AND METHODS: Eighty-four healthy girls aged from 9.8 to 14.7 years were included into this study. After careful physical examination all girls were divided into three groups according to pubertal development. To assess pubertal stage we performed breast examination according to Tanner (bd). Group I consisted of 26 girls in prepubertal stage (1 of bd); group II (stage 2 and 3 of bd) 29 girls, and group III (stage 4 and 5 of bd)--27 girls. Serum concentration of PICP (C-terminal propeptide of type I collagen), PIIINP (N-terminal propeptide of type III collagen, as well as IGF-I were assessed by RIA methods. RESULTS: The highest mean values of serum PICP and PIIINP were found in girls in the second group (stage 2 and 3 of bd) whereas the lowest values were observed in group III (stage 4 and 5 of bd). The mean serum concentration of IGF-I presented a steady increase as puberty advanced being highest in girls in group III. No correlation was found between IGF-I and PICP and IGF-I and PIIINP. A positive correlation were observed between mean serum concentration of IGF-I and age (R = 0.52; p < 0.0001), height (R = 0.51; p < 0.0001), and body weight (R = 0.47; p < 0.0001) in investigated groups. CONCLUSIONS: Although IGF-I showed a steady increase during puberty no correlation was observed between its serum concentration and markers of collagen biosynthesis (PICP and PIIINP).

Adolescent↗
PubMedDate not supplied

[Precocious puberty, Gh deficiency and obesity can affect final height in patients with myelomeningocele: comparison of males and females].

Patients with myelomeningocele show an increased incidence of endocrinological disorders during their childhood. These disorders can ulteriorly affect the adult height of these patients who are already extremely short. In the present study we determined the final height in 21 patients (11 females aged 20.55 +/- 3.54 years; 10 males aged 20.99 +/- 2.94 years) with myelomeningocele. The endocrinological implications were investigated by clinical and laboratory assessment at control and an accurate retrospective evaluation of individual clinical history. Auxological data indicated that in male patients mean final height was significantly less (P < 0.05) than target height, but in females the difference between final height and target height was even more marked (P < 0.001). Comparison of SDS for adult height between males (-2.04 +/- 1.89) and females (-4.36 +/- 2.24) evidenced a statistically significant difference (P < 0.05). The analysis of endocrinological data showed that 7 females had had precocious puberty not treated; no case of precocious puberty was evidenced in males. In 4 females we observed plasmatic IGF-1 and IGFBP-3 concentrations significantly reduced either for chronological age and pubertal stage; this finding emerged in only 1 male. Plasmatic thyroid hormone and adrenal steroid concentrations resulted normal in both groups. Finally, obesity, considered as BMI > 90%, resulted present since childhood in 4 females and 2 males. Our data show that females with myelomeningocele have a statistically greater decrease of their adult stature respect to males. This difference is probably due to a more significant incidence in females of endocrinological diseases. Thus, we believe that a better statural prognosis may be joined in these patients (particularly in girls), through a careful endocrinological follow-up, performed from their births, in order to ensure a prompt identification and treatment of the cases of precocious puberty, impaired GH secretion or obesity.

Adolescent↗
PubMed1999

[Bone mass evolution in patients with precocious and advanced puberty treated with LHRH analogs].

OBJECTIVE: Our aim was to know the long-term effects of treatment with LHRH analogs on the bone mass of patients with precocious or advanced puberty. PATIENTS AND METHODS: Forty-six patients (11 boys and 35 girls) received a-LHRH throughout a 2-year period. The diagnoses were precocious or advance puberty alone or associated to other pathologies. The bone mass was indirectly estimated by measuring the cortical thickness (CT) and the metacarpal diameter (BD) of the 2nd, 3rd, and 4th metacarpals, taking as a reference values the results of the longitudinal Aragonese study of the "Andrea Prader" Center. RESULTS: The CT was 1.3 SD at the beginning and decreased to 0.3 SD (p < 0.002) by the end of therapy and continuing losing to reach 0.1 SD after withdrawal. The BA decreased from 0.8 SD to 0.7 SD (p < 0.0002) and continued decreasing to reach 0.5 SD after withdrawal (p < 0.05). The BD went from -0.64 to -0.62 and to -0.9 SD (p < 0.04) after withdrawal. The longitudinal study of the same 18 cases gave similar results. No significant difference was found between sexes. CONCLUSIONS: In precocious or advance puberty, the bone age and the cortical thickness are increased. After two years of treatment with a-LHRH both decreased significantly and stabilized one year after its suppression. The BD does not change during the treatment, but continues losing value thereafter. This loss of bone mass, not well known in this pediatric situation, is probably related to estrogen deprivation and needs the attention of the physician in order to take possible preventative measures.

Adolescent↗
PubMed1999

Management of puberty in growth hormone deficient children.

The pubertal growth spurt accounts for approximately one-eighth of adult height and is regulated by complex hormonal interactions involving the somatotropic and gonadal axes. The observation that children with growth hormone deficiency (GHD) may fail to achieve an appropriate pubertal growth spurt led to the development of strategies to optimize GH therapy during puberty. In one strategy the dosage of GH is increased during puberty to support pubertal growth and in keeping with the physiological increase in serum levels of the hormone seen at that age. A different approach is to combine a GnRH analog (GnRHa) to GH to stop pubertal development, delaying epiphyseal fusion and prolonging peripubertal growth. Both strategies require caution. As regards the first strategy, too high doses of GH may shorten the pubertal time for growth; we found a small, nonsignificant, improvement in final height by increasing the dose by less than half. Preliminary results on the second strategy are more encouraging. However, manipulation of puberty should be limited to selected patients who show a statural height SDS for bone age unfavorable in terms of height prognosis.

Adolescent↗
PubMed2000

[Selected markers of bone metabolism in boys with constitutional delay of growth and puberty].

The aim of the study was to determine serum concentration and urinary excretion of selected parameters of bone metabolism in boys with constitutional delay of growth and puberty (CDGP) in the relation to pubertal stages. The study group consisted of 41 boys (aged 8 to 18 yrs) with CDGP. Patients were divided on the basis of Tanner's criteria into 4 groups according to the pubertal stage. Serum alkaline phosphatase (AP) activity and serum osteocalcin (OC) concentration as markers of bone growth, as well as urinary deoxypyridinoline (DPD) as a marker of bone resorption were determined. Serum AP activity in 31 (75.6%) boys was within normal age range. Mean values of serum AP activity increased insignificantly from I to IV stage of puberty. Serum OC concentrations were normal in 33 (80.5%) patients. Eight (19.5%) boys showed decreased values of serum OC concentration. Mean OC concentration insignificantly increased with the pubertal stages. DPD urinary excretion was within normal age range in all patients and was the highest in stage III of pubertal stage. No significant abnormalities of bone metabolism parameters in boys with constitutional delay of growth and puberty were found.

Alkaline Phosphatase↗
PubMed2000

[Age and experience of puberty in young Tunisian girls].

The puberty is an important period in woman life. We have tried to determine the age of the puberty, the chronology of its events and the real life of this period of preparation to reproductive life of tunisian girl student by an inquiry. The middle age of puberty is 13 years. It depends of sociological, economic and environmental factors. Knowledges about reproductive life are still insufficient for this age group bracket of high risks of non desired pregnancies and sexually transmittable diseases.

Adaptation, Psychological↗
PubMed2000

[The role of dehydroepiandrosterone sulfate during puberty in girls].

OBJECTIVES: The serum concentration of dehydroepiandrosterone sulfate (DHEAS) in relation to serum levels of follicle stimulating hormone, estradiol, insulin-like growth factor I (IGF-I) and height and weight velocity in girls during puberty were studied. MATERIAL AND METHODS: One hundred and forty nine healthy girls aged from 9.8 to 14.7 years were divided, after physical examination, into four groups according to pubertal development. Serum concentration of DHEAS, FSH, estradiol, cortisol and IGF-I were assessed by RIA methods. One hundred and thirteen girls were examined anthropometrically again and annual increases of body height and weight were analysed concomitantly with DHEAS concentration. RESULTS: The mean serum concentration of DHEAS, FSH, estradiol and IGF-I increase progressively throughout puberty, while cortisol concentration remains constant. Positive correlation was found between DHEAS and FSH as well as between DHEAS and estradiol and IGF-I concentration. No correlation was found between DHEAS and growth velocity. CONCLUSIONS: DHEAS might play an important role during girls puberty although its exact role is very difficult to establish because this steroid works mainly as a precursor for both estrogen and androgen formation.

Adolescent↗
PubMed2002

Precocious puberty in a female with Proteus Syndrome.

Proteus syndrome is a complex disorder comprising malformations and overgrowth of multiple tissues and characterized by its polymorphism and mosaicism. The syndrome is rare and sporadic. Oliveira M da C et al reported the first case of Proteus syndrome associated with precocious puberty in a boy. We are reporting a case of a 7-month old girl with Proteus syndrome who developed a juvenile granulosa cell tumor in one ovary causing precocious puberty. At our knowledge this is the first case of Proteus syndrome with precocious puberty in a female.

Female↗
PubMed2002

Childhood vulvar lichen sclerosus. The course after puberty.

OBJECTIVE: To identify girls with vulvar lichen sclerosus (LS) and to follow them through puberty, documenting the course of the disease. STUDY DESIGN: Twenty-one postpubertal girls were identified from a cohort of 75 girls with LS presenting prepubertally and attending a pediatric vulvar clinic. Details of current symptoms, findings on examination and treatment needs were recorded. A database of 263 women with LS was reviewed for onset of LS premenarche. RESULTS: Of the 21 postpubertal girls, 16 reported an improvement in symptoms, but 11 stated that they still experienced occasional pruritus, requiring intermittent topical steroid application. Although the disorder appeared less active in most cases, definite physical signs persisted in 16 patients (75%); in 5 patients no physical signs of the disease remained. Of 251 postmenopausal women with LS, < 5 could recall symptoms in childhood. Of 12 young adult premenopausal patients with vulvar LS, 4 could recall symptoms in childhood. One of these, a 32-year-old with well-documented LS in childhood resolving at puberty, presented with and died of vulvar squamous cell carcinoma (SCC). CONCLUSION: Patients should be aware that LS may improve symptomatically but usually does not entirely resolve at puberty and that the disease in women may be associated with development of vulvar SCC. Ideally, long-term follow-up should be the standard of care.

Adolescent↗
PubMed2003

The perils of puberty.

Puberty and adolescence represent a transitional phase from childhood to adulthood, and are defined by the attainment of secondary sexual characteristics and reproductive capability, occurring concomitantly with psychological and social development. The perils of puberty lie in the difficult and complex inter-relationship of biological, psychological and social changes, as the adolescent strives to adjust to new social roles and identities, and new reproductive capacities. An appreciation of these changes in normal puberty is essential to all professionals caring for adolescents.

Adolescent↗
PubMed2003

Puberty in disorders of somatosexual differentiation.

Despite enormous advances in the understanding of the molecular mechanisms of sexual differentiation, the medical decisions made in patients with disorders of somatosexual differentiation are mostly lacking evidence-based principles. Recent critical discussions have focused on approaches to gender assignment in infants with ambiguous genitalia. These decisions must be based on the correct diagnosis to be able to predict the development during puberty and adulthood in the affected individual. Puberty in this process plays a pivotal role not only because of the physical changes induced by endogenous or supplementary sex steroids to enhance the sex of rearing, but it is also the time for sexual orientation and promotion of gender identity. In this review we focus not only on the molecular impact of sex steroid action, but also view current opinions and studies on the gender development of the intersex patient during puberty.

Disorders of Sex Development↗
PubMed1992

[Puberty changes and various aspects of cervicovaginal infection].

The changes seen during puberty tend to modify genital anatomical, biochemical, immunological and microbiological conditions, which when associated to epidemiological factors, determine the participation of different infectious agents in pre-puberty women and women going through puberty. It is convenient to be aware of the biological variations which occur in these ages since it aids the clinician in the diagnosis and treatment of pathological vaginal secretions of girls and adolescents.

Algorithms↗
PubMed2003

[Effect of Chinese herbal medicine for nourishing yin and purging fire on mRNA expressions of gonadotropin-releasing hormone and its receptor in precocious puberty model rats].

OBJECTIVE: To probe the mechanism of Chinese herbal medicine (CHM) for nourishing Yin and purging Fire on the expressions of gonadotropin-release hormone (GnRH) and its mRNA expression in hypothalamus and GnRH receptor mRNA in pituitary in danazol induced precocious puberty model rats. METHODS: Rats were divided into the normal group, the model group, the blank control group and the CHM group. Rats, except that in the normal group, were subcutaneously administered danazol 300 micrograms at 5 days of age individually and CHM was fed to rats in the CHM group from 15 days of age, in the meantime, normal saline was fed to rats in the blank control group. Expression of GnRH in hypothalamus was observed by immunohistochemical method and expressions of GnRH mRNA in hypothalamus and GnRH receptor mRNA in pituitary were determined by RT-PCR. RESULTS: Compared with rats in the normal groups, the vaginal opening and the onset of first estrus were ahead of time, the number of GnRH immunoreactive positive cells decreased and the expressions of GnRH mRNA in hypothalamus and GnRH receptor mRNA in pituitary up-regulated in the model rats and blank control rats. Compared with the model and the blank control groups, in CHM group, all the above-mentioned abnormally changed parameters improved significantly after treatment. CONCLUSION: CHM for nourishing Yin and purging Fire may inhibit the abnormal hyperfunction of hypothalamus-pituitary-ovary axis in precocious puberty rat induced by danazol via reducing the synthesis and release of GnRH, and lowering the responsibility of pituitary cells to GnRH. This may be the primary mechanism of CHM in effectively treating the true precocious puberty.

Animals↗
PubMed2003

[The fluctuation of anterior teeth colouration during the period of growth puberty in children and adolescents].

OBJECTIVE: This study was designed to examine the fluctuation tendency of the anterior teeth coloration during the period of growth puberty. METHODS: One hundred children with average age of 13.3 years, and 100 adolescents with average age of 23.4 years were divided into two groups. The upper left incisors were selected for color matching using computerized spectrophotometery system (Shade-eye, Shofu). The measurements depicting color properties, including hue, value and chroma were quantitatively analyzed. Statistical evaluation was conducted for the comparison of the color measurements between the two groups. RESULTS: The following trends were indicated during the period of growth puberty: (1)The hue of the coloration changed from redness into mixture of redness and grayness. (2)The magnitude of value of the coloration was in decline. (3)The intensity of chroma increased significantly. CONCLUSIONS: The teeth coloration fluctuates within the period spanning the initial and final stages of growth puberty, characterized by a decrease in hue and value and an increase in chroma.

Adolescent↗
PubMedDate not supplied

Staging puberty in slipped capital femoral epiphysis: importance of the triradiate cartilage.

In 83 children with slipped capital femoral epiphysis, puberty was staged at the time of diagnosis using bone age, closure of triradiate cartilage, Risser index, and the pubertal diagram of Dimeglio. In boys 95% and in girls 83% of slips occurred during the accelerating phase of puberty (stage 1 and 2), in which mainly the limbs grow. In boys (54%) and in girls (66%), most slips occurred in stage 1. The triradiate cartilage was still open at the time of diagnosis in 65% of boys and 64% of girls. Staging puberty is useful to differentiate the risk for slipped capital femoral epiphysis and to evaluate the risk for a contralateral slip. Closure of the triradiate cartilage is a simple measure to identify this risk. Once the triradiate cartilage is closed, there is a 4% chance of a contralateral slip.

Adolescent↗
PubMed2004

[The comparative study on maturation of metacarpal bone in puberty children during their growth spurt period between urban and rural areas].

OBJECTIVES: To study maturation of the metacarpal bone in puberty children during their growth spurt period and its difference between urban and rural areas. METHODS: Totally, 560 pupils/students were selected from primary and secondary schools in urban and rural areas each, with 35 children in each gender and age group, ranging 12 - 15 years of age for boys and 10 - 13 for girls. An X-ray film of left hand-wrist site was taken for each of them. Length and width of the metacarpal bone were measured and the metacarpal index was calculated. RESULTS: Increment of length of the metacarpal bone was great in puberty children both in urban and rural areas, (6.26 - 9.31) mm in boys and (5.28 - 9.12) mm in girls. Mean length of the metacarpal bone was longer in children of urban areas than that of rural ones, regardless of their age and gender. There was significant difference in mean length of the metacarpal bone between boys aged 14 - 15 years and girls aged 12. Mean width of the metacarpal bone in most children was wider in rural areas than that in urban ones. Mean metacarpal index in children was higher in urban areas than that in rural ones, with very statistical significance, except for girls of 13 year age group. The peak age of metacarpal maturation was 1 year earlier in urban areas than in rural ones. CONCLUSIONS: Maturation of the metacarpal bone was rapid during puberty growth spurt period, with relatively significant difference in urban and rural ares.

Adolescent↗