Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
International Journal of Pediatric Endocrinology
Published in: International Journal of Pediatric Endocrinology 1/2016

Open Access 01-12-2016 | Research

Increasing incidence of premature thelarche in the Central Region of Denmark - Challenges in differentiating girls less than 7 years of age with premature thelarche from girls with precocious puberty in real-life practice

Authors: Mia Elbek Sømod, Esben Thyssen Vestergaard, Kurt Kristensen, Niels Holtum Birkebæk

Published in: International Journal of Pediatric Endocrinology | Issue 1/2016

Login to get access

Abstract

Background

Premature thelarche (PT) seems to be increasing and it is difficult to differentiate its early stages from precocious puberty (PP). Clinical and biochemical parameters are warranted to differentiate the two diagnoses.

Methods

One hundred ninety-one girls aged 0.5–7 years were included. Diagnoses were validated and the girls were categorized to the groups PP (n = 27) and PT (n = 164). Anthropometry, Tanner stages, ethnicity, bone age, and biochemistry, were recorded. Conventional variables for diagnosing PP were compared between the groups at time of referral to identify parameters predictive for the diagnosis.

Results

The referral rate of PT increased from 1998–2013. Girls with PT and PP differed with regards to age at referral, body mass index standard deviation scores (BMISDS), ethnicity, bone age advancement, basal luteinizing hormone (LH), gonadotropin releasing hormone (GnRH) stimulated LH and follicle stimulating hormone (FSH), basal and stimulated LH/FSH ratio, and sex-hormone binding globulin (SHBG). Apart from SHBG there was considerable overlap of the variables between the PT and the PP groups.

Conclusions

First, the incidence of PT appears to increase. Second, SHBG was the variable which best discriminated PT from PP. Third, stimulated LH in 1–3 years old girls with PT is similar to stimulated LH in 5–7 years old girls with PP. Age, BMISDS, ethnicity, bone age, stimulated gonadotropins and LH/FSH and SHBG are all useful variables for differentiating PP from PT. However normative data for stimulated LH and FSH in the age group 0.5–7 years are warranted.
Literature
1.
Teilmann G, Pedersen CB, Jensen TK, Skakkebæk NE, Juul A. Prevalence and incidence of precocious pubertal development in Denmark: an epidemiologic study based on national registries. Pediatrics. 2005;116(6):1323–8.CrossRefPubMed
2.
Sørensen K, Mouritsen A, Aksglade L, Hagen CP, Mogensen SS, Juul A. Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty. Horm Res Paediatr. 2012;77:137–45.CrossRefPubMed
3.
Aksglaede L, Sorensen K, Petersen JH, Skakkebaek NE, Juul A. Recent decline in age at breast development: the Copenhagen Puberty Study. Pediatrics. 2009;123:e932–9.CrossRefPubMed
4.
Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update. 2004;10(2):135–47.CrossRefPubMed
5.
Michaud PA, Suris JC, Deppen A. Gender-related psychological and behavioural correlates of pubertal timing in a national sample of Swiss adolescents. Mol Cell Endocrinol. 2006;254-255:172–8.CrossRefPubMed
6.
Mrug S, Elliott MN, Davies S, Tortolero SR, Cuccaro P, Schuster MA. Early puberty, negative peer influence, and problem behaviors in adolescent girls. Pediatrics. 2014;133(1):7–14.PubMedCentralCrossRefPubMed
7.
Ahlgren M, Melbye M, Wohlfahrt J, Sørensen TIA. Growth patterns and the risk of breast cancer in women. N Engl J Med. 2004;351:1619–26.CrossRefPubMed
8.
Frontini MG, Srinivasan SR, Berenson GS. Longitudinal changes in risk variables underlying metabolic syndrome X from childhood to young adulthood in female subjects with a history of early menarche: the Bogalusa Heart study. Int J Obes Relat Metab Disord. 2003;27:1398–404.CrossRefPubMed
9.
10.
Atay Z, Turan S, Guran T, Furman A, Bereket A. The prevalence and risk factors of premature thelarche and pubarche in 4- to 8-year-old girls. Acta Paediatr. 2012;101:71–5.CrossRef
11.
Van Winter JT, Noller KL, Zimmerman D, Melton LJ. Natural history of premature thelarche in Olmsted County, Minnesota, 1940 to 1984. J Pediatr. 1990;116:278–90.CrossRefPubMed
12.
Bizzarri C, Spadoni GL, Botarro G, Montanari G, Giannone G, Cappa M, et al. The response to gonadotropin releasing hormone (GnRH) stimulation test does not predict the progression to true precocious puberty in girls with onset of premature thelarche in the first three years of life. J Clin Endocrinol Metab. 2014;99(2):433–9.CrossRefPubMed
13.
Pasquino AM, Pucarelli I, Passeri F, Segni M, Mancini MA, Municchi G. Progression of premature thelarche to central precocious puberty. J Pediatr. 1995;126:11–4.CrossRefPubMed
14.
De Vries L, Guz-Mark A, Lazar L, Reches A, Phillip M. Premature thelarche: age at presentation affects clinical course but not clinical characteristics or risk to progress to precocious puberty. J Pediatr. 2010;156(3):466–71.CrossRefPubMed
15.
Carel JC, Eugster EA, Rogol A, Ghizzoni L, Palmert MR, Antoniazzi F, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123:752–62.CrossRef
16.
De Vries L, Horev G, Schwartz M, Phillip M. Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche. Eur J Endocrinol. 2006;154:891–8.CrossRefPubMed
17.
18.
Nysom K, Mølgaard C, Hutchings B, Michaelsen KF. Body mass index of 0 to 45-y-old Danes: reference values and comparison with published European reference values. Int J Obes. 2001;25:177–84.CrossRef
19.
Sun SS, Schubert CM, Chumlea WC, Roche AF, Kulin HE, Lee PA, et al. National estimates of the timing of sexual maturation and racial differences among US children. Pediatrics. 2002;110(5):911–9.CrossRefPubMed
20.
Wu T, Mendola P, Buck GM. Ethnic differences in the presence of secondary sex characteristics and menarche among US girls: the Third National Health and Nutrition Examination Survey, 1988-1994. Pediatrics. 2002;110(4):752–7.CrossRefPubMed
21.
Chauhan A, Grissom M. Disorders of childhood growth and development: precocious puberty. FP Essent. 2013;410:25–31.PubMed
22.
Gaspari L, Morcrette E, Jeandel C, Valé FD, Paris F, Sultan C. Dramatic rise in the prevalence of precocious puberty in girls over the past 20 years in the south of France. Horm Res Ped. 2014;82 suppl 1:291–92.
23.
Elmlinger MW, Kühnel W, Ranke MB. Reference ranges for serum concentrations of Lutropin (LH), follitropin (FSH), estradiol (E”), prolactin, progesterone, sex hormone-binding globuline (SHBG), dehydroepiandrosterone sulfate (DHEAS), cortisol and ferritin in neonates, children and young adults. Clin Chem Lab Med. 2002;40(11):1151–60.CrossRefPubMed
24.
Curfman AL, Reljanovic SM, McNeils KM, Dong TT, Lewis SA, Jackson LW, et al. Premature thelarche in infants and toddlers: prevalence, natural history and environmental determinants. J Pediatr Adolesc Gynecol. 2011;24(6):338–41.CrossRefPubMed
25.
Pasquino AM, Tebaldi L, Cioschi L, Cives C, Finocchi G, Maciocci M, et al. Premature thelarche: a follow up study of 40 girls. Natural history and endocrine findings. Arch Dis Child. 1985;60(12):1180–2.PubMedCentralCrossRefPubMed
26.
Batubara JRL, Suranto A, Sastroasmoro S, Tridjaja B, Pulungan AB. Natural history of premature thelarche: review of 60 girls. Paediatr Indones. 2001;41:279–83.
27.
Teilmann G, Petersen JH, Gormsen M, Damgaard K, Skakkebæk NE, Jensen TK. Early puberty in internationally adopted girls: hormonal and clinical markers of puberty in 276 girls examined bianually over two years. Horm Res. 2009;72:236–46.CrossRefPubMed
28.
Kaplowitz PB, Slora EJ, Wasserman RC, Pedlow SE, Herman-Giddens ME. Earlier onset of puberty in girls: relation to increased body mass index and race. Pediatrics. 2001;108(2):347–53.CrossRefPubMed
29.
Neely EK, Hintz RL, Wilson DM, Lee PA, Gautier T, Argente J, et al. Normal ranges for immunochemiluminometric gonadotropin assays. J Pediatr. 1995;127:40–6.CrossRefPubMed
30.
Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL. Spontaneus serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatr. 1995;127:47–52.CrossRefPubMed
31.
Pescovitz OH, Hench KD, Barnes KM, Loriaux DL, Cutler Jr GB. Premature thelarche and central precocious puberty: the relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone. J Clin Endocrinol Metab. 1988;67(3):474–9.CrossRefPubMed
32.
Palmert MR, Malin HV, Boepple PA. Unsustained or slowly progressive puberty in young girls: initial presentation and long-term follow-up of 20 untreated patients. J Clin Endocrinol Metab. 1999;84(2):415–23.PubMed
33.
Kuiri-Hänninen T, Sankilampi U, Dunkel L. Activation of the hypothalamic-pituitary-gonadal axis in infancy: minipuberty. Horm Res Paediatr. 2014;82:73–80.CrossRefPubMed
Metadata
Title
Increasing incidence of premature thelarche in the Central Region of Denmark - Challenges in differentiating girls less than 7 years of age with premature thelarche from girls with precocious puberty in real-life practice
Authors
Mia Elbek Sømod
Esben Thyssen Vestergaard
Kurt Kristensen
Niels Holtum Birkebæk
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal of Pediatric Endocrinology / Issue 1/2016
Electronic ISSN: 1687-9856
DOI
https://doi.org/10.1186/s13633-016-0022-x

Other articles of this Issue 1/2016

International Journal of Pediatric Endocrinology 1/2016 Go to the issue

Case report

Growth and descent of the testes in infants with hypogonadotropic hypogonadism receiving subcutaneous gonadotropin infusion

Case report

Delayed methimazole-induced agranulocytosis in a 6-year old patient with Graves’ disease

Commentary

Do 6-8 year old girls with central precocious puberty need routine brain imaging?

Research

Efficacy of growth hormone replacement on anthropometric outcomes, obesity, and lipids in children with optic nerve hypoplasia and growth hormone deficiency

Research

Pediatric thyroid surgery and management of thyroid nodules – an institutional experience over a 10-year period

Research

Differential effects of hydrocortisone, prednisone, and dexamethasone on hormonal and pharmacokinetic profiles: a pilot study in children with congenital adrenal hyperplasia