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Alonso GF. Precocious puberty, pandemic and beyond. Pituitary 2024:10.1007/s11102-024-01434-8. [PMID: 39060817 DOI: 10.1007/s11102-024-01434-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 07/28/2024]
Abstract
WHO declared SARS-COVID19 a pandemic in March 2020. Most governments declared health emergency states and implemented various measures. Since then, changes in the reasons for medical consultations were observed in healthcare institutions. Pediatric endocrinologists perceived an increase in the number of consultations related to early or accelerated CPP during the months following the lockdown that different governments had established. Several papers reported the increment in incidence in Central Precocious Puberty, especially in girls. Reports from different parts of the world highlighted a two to threefold rise in the number of cases of precocious puberty treated in Pediatric Endocrinology Centers. This trend of CPP incidence strongly suggests that changes in habits and the environment in which boys and girls were immersed during the lockdown, have played a significant role in triggering the early onset of the gonadotrophic axis.
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Affiliation(s)
- Guillermo F Alonso
- Pediatric Endocrinology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Szakács H, Mutlu MC, Balestrieri G, Gombos F, Braun J, Kringelbach ML, Deco G, Kovács I. Navigating Pubertal Goldilocks: The Optimal Pace for Hierarchical Brain Organization. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2308364. [PMID: 38489748 DOI: 10.1002/advs.202308364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/22/2024] [Indexed: 03/17/2024]
Abstract
Adolescence is a timed process with an onset, tempo, and duration. Nevertheless, the temporal dimension, especially the pace of maturation, remains an insufficiently studied aspect of developmental progression. The primary objective is to estimate the precise influence of pubertal maturational tempo on the configuration of associative brain regions. To this end, the connection between maturational stages and the level of hierarchical organization of large-scale brain networks in 12-13-year-old females is analyzed. Skeletal maturity is used as a proxy for pubertal progress. The degree of maturity is defined by the difference between bone age and chronological age. To assess the level of hierarchical organization in the brain, the temporal dynamic of closed eye resting state high-density electroencephalography (EEG) in the alpha frequency range is analyzed. Different levels of hierarchical order are captured by the measured asymmetry in the directionality of information flow between different regions. The calculated EEG-based entropy production of participant groups is then compared with accelerated, average, and decelerated maturity. Results indicate that an average maturational trajectory optimally aligns with cerebral hierarchical order, and both accelerated and decelerated timelines result in diminished cortical organization. This suggests that a "Goldilocks rule" of brain development is favoring a particular maturational tempo.
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Affiliation(s)
- Hanna Szakács
- Laboratory for Psychological Research, Pázmány Péter Catholic University, 1 Mikszáth Square, Budapest, 1088, Hungary
- Semmelweis University Doctoral School, Division of Mental Health Sciences, 26 Üllői road, Budapest, 1085, Hungary
| | - Murat Can Mutlu
- Institute of Biology, Otto-von-Guericke University, 44 Leipziger Straße, 39120, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, 44 Leipziger Straße, 39120, Magdeburg, Germany
| | - Giulio Balestrieri
- Center for Brain and Cognition, Universitat Pompeu Fabra, 25-27 Ramon Trias Fargas, Barcelona, 08005, Spain
| | - Ferenc Gombos
- Laboratory for Psychological Research, Pázmány Péter Catholic University, 1 Mikszáth Square, Budapest, 1088, Hungary
- HUN-REN-ELTE-PPKE Adolescent Development Research Group, 1 Mikszáth Kálmán Square, Budapest, 1088, Hungary
| | - Jochen Braun
- Institute of Biology, Otto-von-Guericke University, 44 Leipziger Straße, 39120, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Otto-von-Guericke University, 44 Leipziger Straße, 39120, Magdeburg, Germany
| | - Morten L Kringelbach
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Wellington Square, Oxford, OX3 9BX, UK
- Department of Psychiatry, University of Oxford, Wellington Square, Oxford, OX3 7JX, UK
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Nordre Ringgade 1, Aarhus, 8000, Denmark
| | - Gustavo Deco
- Center for Brain and Cognition, Universitat Pompeu Fabra, 25-27 Ramon Trias Fargas, Barcelona, 08005, Spain
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, 122-140 Carrer de Tànger, Barcelona, 08018, Spain
- Institució Catalana de la Recerca i Estudis Avançats (ICREA), 23 Passeig de Lluís Companys, Barcelona, 08010, Spain
| | - Ilona Kovács
- HUN-REN-ELTE-PPKE Adolescent Development Research Group, 1 Mikszáth Kálmán Square, Budapest, 1088, Hungary
- Institute of Psychology, Faculty of Education and Psychology, Eötvös Loránd University, 25-27 Kazinczy Street, Budapest, 1075, Hungary
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Kostopoulou E. The Interplay Between COVID-19 and Pediatric Endocrine Disorders. What have we Learned After More than Three Years of the Pandemic? Horm Metab Res 2024; 56:181-192. [PMID: 37673081 DOI: 10.1055/a-2152-4590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
As an increased body of COVID-19 related research is now available, it becomes apparent that the effects of COVID-19 extend beyond that of the respiratory system. Among others, the endocrine system is particularly vulnerable to perturbation from the COVID-19 infection. The present scoping review summarizes the bidirectional relationship between COVID-19 and endocrine system in children and adolescents, by describing both the possible susceptibility of children and adolescents without endocrinopathies to endocrine disorders following COVID-19 infection, but also the potential susceptibility to COVID-19 infection and severe infection, or the aggravation of endocrine dysfunction in patients with pre-existing endocrine diseases. Data suggest increased obesity and diabetes rates, as well as increased severity and frequency of diabetic ketoacidosis following COVID-19 infection. Conversely, patients with diabetes and obesity may experience a more severe course of COVID-19 infection. However, in the majority of cases, children and adolescents with well-managed and regulated endocrine disorders do not appear to be at increased risk of infection or severe infection from COVID-19. Thus, adhering to the appropriate "sick day management rules", maintaining adequate supply of medications and supplies, keeping close contact with the therapeutic team and seeking medical help without delay when needed, are the main recommendations for a safe outcome. Additional lessons learnt during the pandemic include the risk for mental health diseases caused by children's disrupted routine due to COVID-19 related protective measures and the importance of adopting alternative communication options, such as telehealth visits, in order to ensure uninterrupted endocrine care.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, Patras, Greece
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Hoskyns RB, Howard SR. Effects of the COVID-19 pandemic on the incidence of central precocious puberty; a narrative review. J Pediatr Endocrinol Metab 2024; 37:102-109. [PMID: 38097507 DOI: 10.1515/jpem-2023-0507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024]
Abstract
Central precocious puberty (CPP) is the premature activation of the hypothalamus-pituitary-gonadal axis, resulting in the early development of secondary sexual characteristics. CPP classically occurs before the age of 8 years in girls and 9 years in boys. The aetiology of this precocious onset of puberty is governed by complex mechanistic interactions between genetic and environmental factors. The rates of CPP have been documented to have been rising before the COVID-19 pandemic; despite this, the incidence of CPP has increased exponentially since the start of the pandemic. There are multiple theories potentially explaining this change in incidence of CPP over COVID-19. These include the direct effect of SARS-coV-2 infection, increasing body mass index of adolescents over sequential lockdowns, changes in sleep patterns, increased use of electronic devices and levels of stress, and additionally potential earlier detection of signs of CPP by parents and carers. Whilst there is evidence from observational cohorts, case studies and animal models for each of these factors, it is difficult to definitively prove which has had the greatest impact due to the mainly retrospective nature of the human research that has been conducted. Moreover, studies set in diverse settings with varying population make comparison complex. Additionally, each country responded differently to the COVID-19 pandemic and the lockdowns varied between locations, hence the effect of lockdown was not equal or universal. Despite this, similar trends have been identified, with various lifestyle changes that occurred over the pandemic being potentially influential factors on the development of CPP.
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Affiliation(s)
- Rebecca B Hoskyns
- Barts and the London School of Medicine and Dentistry, QMUL, London, UK
| | - Sasha R Howard
- Centre for Endocrinology, William Harvey Research Institute, QMUL, London, UK
- Department of Paediatric Endocrinology, Royal London Children's Hospital, Barts Health NHS Trust, London, UK
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Yuan S, Lin Y, Zhao Y, Du M, Dong S, Chen Y, Wei H. Pineal cysts may promote pubertal development in girls with central precocious puberty: a single-center study from China. Front Endocrinol (Lausanne) 2024; 15:1323947. [PMID: 38405141 PMCID: PMC10885350 DOI: 10.3389/fendo.2024.1323947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/17/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Pineal cysts have long been considered a benign intracranial variation. However, in our clinical practice, it has been observed that some children with central precocious puberty (CPP) who have pineal cysts experience rapid progression in adolescent development. In recent years, there has been a significant increase in the prevalence of CPP in girls, leading to more diagnoses of CPP among children with pineal cysts. Despite this, there is no consensus regarding whether pineal cysts contribute to CPP as one of its organic factors. This study aimed to analyze the clinical characteristics of pineal cysts in children with CPP and explore the potential effects of pineal cysts on puberty development. Methods This single-center study retrospectively analyzed clinical data from girls aged 3 to 10 years who underwent head/pituitary magnetic resonance imaging at the Children's Hospital Affiliated to Zhengzhou University between 2019 and 2022. The study categorized the detection rates of pineal cysts based on systematic disease classification and compared the rates of cyst detection between girls diagnosed with CPP and those without CPP. Subsequently, CPP-diagnosed girls with pineal cysts were examined. Among CPP-diagnosed girls meeting the study's criteria, those with pineal cysts formed the 'cyst group,' while those without cysts were matched in a 1:1 ratio based on age and body mass index to form the 'non-cyst group.' Comparative analyses were conducted to assess the clinical characteristics between these two groups. CPP-diagnosed girls with cysts were further subdivided into three groups according to cyst size (≤5 mm, 5.1-9.9 mm, and ≥10 mm) to investigate potential differences in clinical characteristics among these subgroups. The study involved an analysis of clinical data from girls diagnosed with CPP and included imaging follow-ups to explore the progression of pineal cysts over time. Results Among the 23,245 girls who underwent head/pituitary magnetic resonance imaging scans, the detection rate of pineal cysts was 3.6% (837/23,245), with most cases being associated with endocrine diseases. The detection rate of pineal cysts in CPP patients was 6.4% (262/4099), which was significantly higher than the 3.0% (575/19,146) in patients without CPP. In comparison to the non-cyst group, the cyst group exhibited statistically significant increases in estradiol levels, peak luteinizing hormone (LH) levels, peak LH/follicle-stimulating hormone (FSH) ratios, uterine body length, and cervix length (P < 0.001). As cyst size increased, there were significant rises in LH peak, peak LH/FSH ratio, uterine body length, and cervical length (P < 0.01). Estradiol levels and left ovarian volume also showed an increasing trend (P < 0.05). Among girls who underwent follow-up imaging, 26.3% (5/19) exhibited an increase in cyst size. Conclusion Pineal cysts are relatively common in children with CPP. They may affect the pubertal development process, with larger cysts correlating to faster pubertal development. Therefore, the authors hypothesize that pineal cysts may trigger CPP in some cases, especially when the cysts are larger than 5 mm in size, as indicated by our data.
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Affiliation(s)
- Shuxian Yuan
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Yifan Lin
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Yixuan Zhao
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Mengmeng Du
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Shijie Dong
- Department of Imaging and Nuclear Medicine, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Yongxing Chen
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
| | - Haiyan Wei
- Department of Endocrinology and Inborn Error of Metabolism, Children’s Hospital Affiliated to Zhengzhou University, Beijing Children's Hospital Zhengzhou Hospital, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Tianjian Laboratory of Advanced Biological Sciences, Zhengzhou, China
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Leong A, Vasanwala RF. Early Puberty Trend during the COVID-19 Pandemic in Singapore: A Retrospective Review in a Single Tertiary Centre. J ASEAN Fed Endocr Soc 2024; 39:6-11. [PMID: 38863916 PMCID: PMC11163325 DOI: 10.15605/jafes.039.01.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/27/2024] [Indexed: 06/13/2024] Open
Abstract
Objectives We aimed to study the trend of referrals for precocious puberty during the COVID-19 pandemic compared to pre-COVID years, explore the differences in the demographic and clinical features, and evaluate the contributing factors. Methodology The cases referred for assessment of PP from 2018-2021 to our endocrine centre were grouped into pre-COVID (2018-2019) and COVID (2020-2021) years. Cases fulfilling the diagnosis of PP included the onset of thelarche <8 years in females and 4 ml testicular volume <9 years in males. The PP was further differentiated as Isolated Thelarche (IST) and Central Precocious Puberty (CPP). Early menarche was defined as menarche <10 years old. Results There were more referrals for PP and more diagnosed as CPP during the COVID-19 pandemic, predominantly among females. There were more endocrine tests done and more cases received treatment. None of the abnormal magnetic resonance imaging (MRI) pituitary findings required surgical intervention. The body mass index (BMI) was found to be positively associated with the risk of getting CPP with a crude-odd ratio (COR) of 1.8, P <0.001, and early menarche (COR 2.1, P <0.001). Conclusion We found a significant increase in the referrals of PP and diagnosis of CPP during the COVID-19 pandemic. Higher BMI was found to be associated with CPP and early menarche.
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Affiliation(s)
- Annie Leong
- Department of Paediatrics, Endocrine Service, KK Women's and Children's Hospital, Singapore
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Zevin EL, Eugster EA. Central precocious puberty: a review of diagnosis, treatment, and outcomes. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:886-896. [PMID: 37973253 DOI: 10.1016/s2352-4642(23)00237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/23/2023] [Accepted: 09/08/2023] [Indexed: 11/19/2023]
Abstract
Central precocious puberty (CPP) refers to early activation of the hypothalamic-pituitary-gonadal (HPG) axis and is manifested by breast development in girls or testicular enlargement in boys before the normal physiological age ranges. CPP can be precipitated by intracranial pathology, exposure to high levels of sex steroids, or environmental risk factors, but most cases are idiopathic. Monogenic causes have also been identified. In this Review, we summarise pathophysiology, risk factors, diagnosis, and management of CPP. Concern for CPP should prompt referral to paediatric endocrinology where diagnosis is confirmed by clinical, biochemical, radiological, and genetic testing. CPP is treated with a gonadotropin-releasing hormone analogue, the primary aims of which are to increase adult height and postpone development of secondary sexual characteristics to an age that is more commensurate with peers. Although long-term outcomes of treatment with gonadotropin-releasing hormone analogues are reassuring, additional research on the psychological effect of CPP is needed.
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Affiliation(s)
- Erika L Zevin
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Erica A Eugster
- Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
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Ahn J, Lee Y, Gim S, Jeong H. Use of the Subcutaneous Triptorelin Stimulation Test for Diagnosis of Central Precocious Puberty. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1830. [PMID: 38002921 PMCID: PMC10669987 DOI: 10.3390/children10111830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The gold standard gonadotropin-releasing hormone (GnRH) stimulation test uses the response to intravenously injected gonadorelin to diagnose central precocious puberty (CPP). However, gonadorelin is not always readily available. OBJECTIVE This study investigated the diagnostic efficacy of the subcutaneous triptorelin test and the optimal blood sampling time for diagnosis of CPP. METHODS This study retrospectively examined the medical records of 220 girls who had undergone either the triptorelin or gonadorelin test and compared their clinical characteristics. We retrospectively compared clinical parameters between girls diagnosed with CPP (n = 111) and idiopathic premature thelarche (IPT) (n = 109) using three different diagnostic methods: the gonadorelin, triptorelin 120 min, and triptorelin 180 min tests. The diagnostic ability of the stimulated luteinizing hormone (LH) concentration in the triptorelin test for CPP was evaluated using receiver operating characteristic (ROC) analysis. RESULTS The CPP group exhibited higher basal and peak gonadotropin levels, more advanced bone age, and a lower body mass index standard deviation score than the IPT group. In the gonadorelin test group, all girls with CPP exhibited a peak LH response 30-60 min after intravenous gonadorelin injection. In the triptorelin test group, most girls with CPP exhibited a peak LH response 60-180 min after subcutaneous triptorelin injection (n = 68). On the ROC curve, a peak LH concentration of ≥ 4.52 IU/L at 120 min had the highest CPP diagnostic accuracy, with sensitivity and specificity of 100% and 95.83%, respectively.
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Affiliation(s)
- Jungmin Ahn
- Department of Pediatrics, School of Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Youngin Lee
- Department of Pediatrics, School of Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Seongmin Gim
- Department of Pediatrics, School of Medicine, Jeju National University, Jeju 63243, Republic of Korea
| | - Hwalrim Jeong
- Department of Pediatrics, School of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea
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Brambilla I, Guarracino C, Pistone C, Klersy C, Licari A, Marseglia GL, Tondina E. Role of luteinizing hormone urinary levels in the diagnostic and therapeutic management of female central precocious puberty. Ital J Pediatr 2023; 49:100. [PMID: 37605205 PMCID: PMC10441738 DOI: 10.1186/s13052-023-01506-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/01/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Diagnosing central precocious puberty (CPP) requires an integrated approach based on clinical, biochemical and instrumental data. The diagnostic gold standard is represented by GnRH (gonadotropin-releasing hormone) stimulation test. Some undoubted limitations of this procedure led the international scientific community to look for cheaper and less invasive alternative diagnostic methods, such as luteinizing hormone urinary levels (uLH) measurement. This study aims to define the reliability of urinary LH levels as a biomarker of pubertal development, both concerning the initial diagnostic management and the monitoring of patients with central precocious puberty undergoing therapy with GnRH analogues. Furthermore, the study plans to detect the potential association between LH peak serum (pLH) and urinary LH in patients undergoing diagnostic tests with GnRH and to identify a possible cut-off of uLH that may be suggestive of ensued successful hormonal stimulation. METHODS The study includes 130 female patients with suspected precocious puberty or in follow-up during suppressive therapy. After the collection of the informed consent, the patients underwent clinical evaluation, auxological assessment, and hormone assays (basal levels of LH, FSH, and oestradiol; GnRH stimulating test in patients with suspected precocious puberty; urinary LH assay on the first-morning urine sample, collected after waking up). RESULTS Two uLH cut-off values have been identified: the first of 0.25 UI/L [C.I. 95% 0.23-0.27], able to distinguish between pubertal and pre-pubertal patients, the second of 0.45 UI/L [C.I. 95% 0,20 - 0,70] suggestive of occurred hormonal stimulation in patients with diagnosis of CPP at GnRH test. All 30 patients with CPP in follow-up during suppressive therapy presented uLH values ≤ 0.45 IU/L (pU < 0.05), and uLH collected in prepubertal group control. CONCLUSIONS uLH assays on the first morning urine specimen could be considered a low-cost and minimally invasive tool for precocious puberty diagnosing and monitoring, making possible to be easily performed even by a general pediatrician. Thus, this could help referring only selected patients to pediatric endocrinologists. After an appropriate validation, this approach could reasonably reduce hospital attendance and costs of performing more invasive procedures, with a more significant emotional impact on the pediatric patient.
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Affiliation(s)
- Ilaria Brambilla
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, p.le C. Golgi 19, Pavia, 27100, Italy.
| | - Carmen Guarracino
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, p.le C. Golgi 19, Pavia, 27100, Italy
| | - Carmelo Pistone
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, p.le C. Golgi 19, Pavia, 27100, Italy
| | - Catherine Klersy
- Department of Epidemiology and Biostatistics, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, p.le C. Golgi 19, Pavia, 27100, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Pediatric Unit, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, p.le C. Golgi 19, Pavia, 27100, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Pediatric Unit, University of Pavia, Pavia, Italy
| | - Enrico Tondina
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Pediatric Unit, University of Pavia, Pavia, Italy
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Calcaterra V, Tagi VM, De Santis R, Biuso A, Taranto S, D’Auria E, Zuccotti G. Endocrinological Involvement in Children and Adolescents Affected by COVID-19: A Narrative Review. J Clin Med 2023; 12:5248. [PMID: 37629291 PMCID: PMC10455095 DOI: 10.3390/jcm12165248] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Since the advent of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increased incidence of several endocrinological anomalies in acute-phase and/or long-term complications has been described. The aim of this review is to provide a broad overview of the available literature regarding changes in the worldwide epidemiology of endocrinological involvement in children since December 2019 and to report the evidence supporting its association with coronavirus disease 2019 (COVID-19). Although little is known regarding the involvement of endocrine organs during COVID-19 in children, the current evidence in adults and epidemiological studies on the pediatric population suggest the presence of a causal association between the virus and endocrinopathies. Untreated transient thyroid dysfunction, sick euthyroid syndrome, nonthyroidal illness syndrome, and hypothalamic-pituitary-adrenal (HPA) axis and central precocious puberty have been observed in children in acute infection and/or during multisystem inflammatory syndrome development. Furthermore, a higher frequency of ketoacidosis at onset in children with a new diagnosis of type 1 diabetes is reported in the literature. Although the direct association between COVID-19 and endocrinological involvement has not been confirmed yet, data on the development of different endocrinopathies in children, both during acute infection and as a result of its long-term complications, have been reported. This information is of primary importance to guide the management of patients with previous or current COVID-19.
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Affiliation(s)
- Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Veronica Maria Tagi
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Raffaella De Santis
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Andrea Biuso
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Silvia Taranto
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, 20154 Milan, Italy; (V.M.T.); (R.D.S.); (A.B.); (S.T.); (E.D.); (G.Z.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20122 Milan, Italy
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Baehr S, Schnabel D, Woelfle J, Schreiner F, Gohlke B. National survey of referrals for precocious puberty in Germany. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2023-001987. [PMID: 37208033 DOI: 10.1136/bmjpo-2023-001987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023] Open
Abstract
An unusual high number of girls were referred to our paediatric endocrine clinic with suspected precocious puberty (PP) since the beginning of the COVID-19 pandemic. We analysed our data and initiated a survey among German paediatric endocrinologists.At our centre, less than 10 patients were diagnosed of PP annually between 2015 and 2019. This increased to n=23 (2020) and n=30 (2021). A German survey confirmed this observation: Out of 44 centres which completed the questionnaire, 30/44 (68%) reported an increase of PP. Above this, 32/44 (72%) stated an increase in girls diagnosed with 'early normal puberty' since the beginning of the COVID-19 pandemic.
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Affiliation(s)
- Sonja Baehr
- Pediatrics, University Hospital Bonn, Bonn, Germany
| | - Dirk Schnabel
- Department of Paediatric Endocrinology and Diabetology, Charite Medical Faculty Berlin, Berlin, Germany
| | - Joachim Woelfle
- Department of Paediatric Endocrinology and Diabetology, Erlangen University Hospital, Erlangen, Germany
| | | | - Bettina Gohlke
- Dep. of Pediatric Endocrinology and Diabetology, University of Bonn, Bonn, Germany
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12
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Sheikh A, Owais R, Ali E, Shaikh A. COVID‐19 and early puberty—An unintended consequence of COVID‐19 lockdown? Dev Psychobiol 2023; 65:e22384. [PMID: 37073592 DOI: 10.1002/dev.22384] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/03/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
The novel coronavirus (SARS-CoV-2) causes the disease COVID-19, also termed as acute atypical pneumonia leading to respiratory failure. Children were more likely to spend time at home due to the lockdown mandated by governments as a preventive measure, which led to alterations in dietary habits and sleeping patterns which could have had a substantial influence on their sexual development, including but not limited to faster onset of puberty. Existing data suggested a plausible relationship between COVID-19 and early puberty. Obesity, physical activity, mental health, and birth weight are major risk factors that have further contributed to the early onset of puberty. In order to address such health crises affecting children, comprehensive solutions are urgently required. As COVID-19 continues to have multiple unpredictable health consequences, spreading awareness regarding this specific problem is of paramount importance.
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Affiliation(s)
- Ayesha Sheikh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabia Owais
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Eman Ali
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Shaikh
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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13
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Early onset of puberty during COVID-19 pandemic lockdown: experience from two Pediatric Endocrinology Italian Centers. J Pediatr Endocrinol Metab 2023; 36:290-298. [PMID: 36607833 DOI: 10.1515/jpem-2022-0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES During COVID-19 pandemic lockdown, reports of evaluations for suspected precocious puberty significantly raised. We aimed to assess the increase of precocious puberty in patients referred to Pediatric Endocrinology Units of Brescia (Italy), to determine clinical characteristics of patients undergoing a GnRH stimulation test before and during lockdown and evaluate the role of environmental factors in pubertal development. METHODS Clinical and biochemical data of patients undergoing GnRH stimulation test were collected and stratified in two groups: March 2019 - February 2020 (Period 1) and March 2020 - February 2021 (Period 2). RESULTS A total number of 391 evaluations for suspected precocious puberty were identified in the two study periods: 183 (46.8%) first visits during Period 1, and 208 (53.2%) in Period 2. Sixty-one patients underwent a GnRH stimulation test (4.1% of first consultations) before the SARS-CoV2 pandemic, and 93 children (8.7%) after the lockdown. Thirty-four new diagnoses of central precocious puberty were registered during Period 1 (2.3%), vs. 45 new cases (4.2%) in Period 2. During lockdown patients evaluated for suspected precocious puberty underwent a stimulation test at younger age than those evaluated before pandemic (median age of 8.2 years vs. 8.4, p=0.04). In Period 2, children showed a median bone age advancement of 0.61 years vs. 1.06 of Period 1 (p=0.03). CONCLUSIONS During the COVID-19 pandemic, we observed an increased proportion of consultations for suspected precocious puberty. These children showed lower bone age advancement than observed in pre-lockdown suggesting the influence of pandemic-related lifestyle changes on pubertal development.
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Di Pietro G, Forcucci F, Chiarelli F. Endocrine Disruptor Chemicals and Children's Health. Int J Mol Sci 2023; 24:2671. [PMID: 36768991 PMCID: PMC9916521 DOI: 10.3390/ijms24032671] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
We are all exposed to endocrine-disrupting chemicals (EDCs) starting from embryonic life. The fetus and child set up crucial developmental processes allowing adaptation to the environment throughout life: they are extremely sensitive to very low doses of hormones and EDCs because they are developing organisms. Considering the developmental origin of well-being and diseases, every adult organism expresses consequences of the environment in which it developed. The molecular mechanisms through which the main EDCs manifest their effects and their potential association with endocrine disorders, such as diabetes, obesity, thyroid disease and alteration of adrenal hormones, will be reviewed here. Despite 40 years having passed since the first study on EDCs, little is yet known about them; therefore, our purpose is to take stock of the situation to establish a starting point for further studies. Since there is plenty of evidence showing that exposure to EDCs may adversely impact the health of adults and children through altered endocrine function-suggesting their link to endocrinopathies-it is essential in this context to bear in mind what is already known about endocrine disruptors and to deepen our knowledge to establish rules of conduct aimed at limiting exposure to EDCs' negative effects. Considering that during the COVID-19 pandemic an increase in endocrine disruptor effects has been reported, it will also be useful to address this new phenomenon for better understanding its basis and limiting its consequences.
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Affiliation(s)
| | | | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti “G. d’Annunzio”, 66100 Chieti, Italy
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15
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Chioma L, Chiarito M, Bottaro G, Paone L, Todisco T, Bizzarri C, Cappa M. COVID-19 pandemic phases and female precocious puberty: The experience of the past 4 years (2019 through 2022) in an Italian tertiary center. Front Endocrinol (Lausanne) 2023; 14:1132769. [PMID: 36926039 PMCID: PMC10011474 DOI: 10.3389/fendo.2023.1132769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
OBJECTIVE Since the outbreak of COVID-19 pandemic, several centers of pediatric endocrinology worldwide have observed a significant increase in the number of girls presenting with precocious or early puberty. We aimed to compare the incidence rates of female precocious puberty before and during the different phases of COVID-19 pandemic. METHODS We have retrospectively analyzed all the consultations recorded in the outpatient clinic database of the Endocrinology Unit of Bambino Gesù Children's Hospital, Rome, Italy, from the lockdown start in March 2020 up to September 2020, in comparison with the consultations recorded in the same months of 2019, 2021 and 2022. Age, height, weight, body mass index, Tanner's pubertal stage and bone age at presentation, birth weight, ethnicity, family history of central precocious puberty (CPP), maternal age at menarche, history of adoption were retrieved from clinical records. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) both at baseline and after gonadotropin-releasing hormone (GnRH) stimulation, and basal estradiol levels were collected. RESULTS In 2019, 78 girls with suspected precocious puberty were referred for endocrinological consultation, compared to 202 girls in 2020, 158 girls in 2021 and 112 girls in 2022. A significant increase in the proportion of girls diagnosed with rapidly progressive CPP was observed in 2020, compared to 2019 (86/202 vs. 18/78, p<0.01). In the following periods of 2021 and 2022, a gradual decrease in the number of cases of progressive CPP was evident, so much that the number of cases was not significantly different from that observed in 2019 (56/158 in 2021 and 35/112 in 2022, p=0.054 and p=0.216 respectively, compared to 2019). CONCLUSIONS Our research suggests that drastic lifestyle changes, such as those imposed by COVID-19 lockdown, and the consequent stress may affect the regulation of pubertal timing. The remarkable increase in CPP cases observed during the 2020 first pandemic wave seems to be reduced in 2021 and 2022, concurrently with the progressive resumption of daily activities. These data seem to support the hypothesis of a direct relationship between profound life-style changes related to the pandemic and the rise in precocious puberty cases.
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Street ME, Ponzi D, Renati R, Petraroli M, D’Alvano T, Lattanzi C, Ferrari V, Rollo D, Stagi S. Precocious puberty under stressful conditions: new understanding and insights from the lessons learnt from international adoptions and the COVID-19 pandemic. Front Endocrinol (Lausanne) 2023; 14:1149417. [PMID: 37201098 PMCID: PMC10187034 DOI: 10.3389/fendo.2023.1149417] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023] Open
Abstract
Neuro-biological variations in the timing of sexual maturation within a species are part of an evolved strategy that depend on internal and external environmental conditions. An increased incidence of central precocious puberty (CPP) has been described in both adopted and "covid-19 pandemic" children. Until recently, it was hypothesised that the triggers for CPP in internationally adopted children were likely to be better nutrition, greater environmental stability, and improved psychological wellbeing. However, following data collected during and after the coronavirus (COVID-19) global pandemic, other possibilities must be considered. In a society with high levels of child wellbeing, the threat to life presented by an unknown and potentially serious disease and the stressful environment created by lockdowns and other public health measures could trigger earlier pubertal maturation as an evolutionary response to favour early reproduction. The main driver for increased rates of precocious and rapidly progressive puberty during the pandemic could have been the environment of "fear and stress" in schools and households. In many children, CPP may have been triggered by the psychological effects of living without normal social contact, using PPE, being near adults concerned about financial and other issues and the fear of getting ill. The features and time of progression of CPP in children during the pandemic are similar to those observed in adopted children. This review considers the mechanisms regulating puberty with a focus on neurobiological and evolutionary mechanisms, and analyses precocious puberty both during the pandemic and in internationally adopted children searching for common yet unconsidered factors in an attempt to identify the factors which may have acted as triggers. In particular, we focus on stress as a potential factor in the early activation of the hypothalamic-pituitary-gonadal axis and its correlation with rapid sexual maturation.
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Affiliation(s)
- Maria Elisabeth Street
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Unit of Paediatrics, P. Barilla Children’s Hospital, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
- *Correspondence: Maria Elisabeth Street,
| | - Davide Ponzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Roberta Renati
- Department of Pedagogy, Psychology and Philosophy, University of Cagliari, Cagliari, Italy
| | - Maddalena Petraroli
- Unit of Paediatrics, P. Barilla Children’s Hospital, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Tiziana D’Alvano
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Unit of Paediatrics, P. Barilla Children’s Hospital, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Claudia Lattanzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Unit of Paediatrics, P. Barilla Children’s Hospital, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Vittorio Ferrari
- Health Sciences Department, University of Florence, Florence, Italy
| | - Dolores Rollo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefano Stagi
- Health Sciences Department, University of Florence, Florence, Italy
- Azienda Ospedaliero Univesitaria Meyer IRCCS, Florence, Italy
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17
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Trujillo MV, Rungvivatjarus T, Klein KO. Incidence of central precocious puberty more than doubled during COVID-19 pandemic: Single-center retrospective review in the United States. Front Pediatr 2022; 10:1007730. [PMID: 36533230 PMCID: PMC9748187 DOI: 10.3389/fped.2022.1007730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
Background and aim of the study The frequency of new visits for precocious puberty increased during the Covid-19 pandemic in the pediatric endocrinology clinic at Rady Children's Hospital in San Diego, CA, US. A few recent studies have shown an increase in the frequency of Central Precocious Puberty (CPP) in other centers during this pandemic. This study evaluated the change in incidence of new CPP cases requiring treatment with GnRH agonist (GnRHa) at Rady Children's Hospital during the Covid-19 pandemic and compared it to pre-pandemic years. Methods Data were reviewed retrospectively to compare the number of visits of children newly diagnosed with CPP treated with GnRHa during the Covid-19 pandemic (5/2020-4/2021) and before the pandemic (5/2018-4/2019). Clinical and bone maturation data were evaluated as well as differences in timing from diagnosis to onset of treatment. The incidence of CPP requiring treatment for 5 years prior to the pandemic was also reviewed to evaluate for trends over time. Results A total of 92 subjects were included. During pre-Covid year, 28 children (1 boy, 27 girls) were treated with GnRHa for CPP out of 2,340 new endocrinology visits (1.2% of patients seen). During Covid-19 year, 64 children (7 boys, 57 girls) were treated out of 2,261 new visits (2.8%). The incidence of new CPP cases requiring GnRHa during the pandemic more than doubled compared to pre-pandemic. Age at onset of treatment, degree of bone age (BA) advancement, time from diagnosis to onset of treatment, and changes in BMI during the pandemic were not different from pre-pandemic. Conclusion CPP cases requiring GnRHa treatment significantly increased during the first year of the Covid-19 pandemic. This was not related to increased BMI or delay in onset of treatment. Age at diagnosis, degree of bone age advancement, and time from diagnosis to onset of treatment were all similar during the first year of the pandemic compared to the prior year.
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Affiliation(s)
- Marcela Vargas Trujillo
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
- Department of Pediatrics, Rady Children's Hospital-San Diego, University of California, San Diego, San Diego, CA, United States
| | - Tiranun Rungvivatjarus
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
- Department of Pediatrics, Rady Children's Hospital-San Diego, University of California, San Diego, San Diego, CA, United States
| | - Karen O. Klein
- Department of Pediatrics, University of California, San Diego, San Diego, CA, United States
- Department of Pediatrics, Rady Children's Hospital-San Diego, University of California, San Diego, San Diego, CA, United States
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18
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Fava D, Calandrino A, Calevo MG, Allegri AEM, Napoli F, Gastaldi R, Patti G, Casalini E, Bassi M, Accogli A, Alyasin ARAA, Ramaglia A, Rossi A, Maghnie M, Morana G, Di Iorgi N. Clinical, Endocrine and Neuroimaging Findings in Girls With Central Precocious Puberty. J Clin Endocrinol Metab 2022; 107:e4132-e4143. [PMID: 35881919 DOI: 10.1210/clinem/dgac422] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The etiology of central precocious puberty (CPP) includes a spectrum of conditions. Girls younger than age 6 years with CPP should undergo cranial magnetic resonance imaging (MRI), but it remains controversial whether all girls who develop CPP between the ages of 6 and 8 years require neuroimaging examination. OBJECTIVE To investigate the frequency of brain MRI abnormalities in girls diagnosed with CPP and the relationship between maternal factors, their age at presentation, clinical signs and symptoms, hormonal profiles, and neuroimaging findings. METHODS Data were collected between January 2005 and September 2019 from 112 girls who showed clinical pubertal progression before 8 years of age who underwent brain MRI. RESULTS MRI was normal in 47 (42%) idiopathic (I) scans, 54 (48%) patients had hypothalamic-pituitary anomalies (HPA) and/or extra-HP anomalies (EHPA), and 11 (10%) had brain tumors or tumor-like conditions (BT/TL), including 3 with neurological signs. Associated preexisting disorders were documented in 16. Girls with BT/TL had a higher LH peak after GnRH test (P = 0.01) than I, and those older than age 6 years had a higher craniocaudal diameter of the pituitary gland (P = 0.01); their baseline FSH and LH (P = 0.004) and peak FSH (P = 0.01) and LH (P = 0.05) values were higher than I. Logistic regression showed maternal age at menarche (P = 0.02) and peak FSH (P = 0.02) as BT/TL risk factors. CONCLUSIONS MRI provides valuable information in girls with CPP by demonstrating that fewer than half have a normal brain MRI and that few can have significant intracranial lesions after the age of 6, despite the absence of suggestive neurological signs.
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Affiliation(s)
- Daniela Fava
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Andrea Calandrino
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | | | - Flavia Napoli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | - Roberto Gastaldi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | - Giuseppa Patti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Emilio Casalini
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Andrea Accogli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
- Department of Specialized Medicine, Division of Medical Genetics, McGill University Health Centre, Montreal H4A 3J1, Canada
- Department of Human Genetics, Faculty of Medicine, McGill University, Montreal H3A 1G1, Canada
| | - Abdel Razaq Ahmad A Alyasin
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Antonia Ramaglia
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa 16142, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
| | - Giovanni Morana
- Department of Neurosciences, Neuroradiology Unit, University of Turin, Turin 10126, Italy
| | - Natascia Di Iorgi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genoa 16147, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa 16142, Italy
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Yüksek Acinikli K, Erbaş İM, Besci Ö, Demir K, Abacı A, Böber E. Has the Frequency of Precocious Puberty and Rapidly Progressive Early Puberty Increased in Girls During the COVID-19 Pandemic? J Clin Res Pediatr Endocrinol 2022; 14:302-307. [PMID: 35633642 PMCID: PMC9422906 DOI: 10.4274/jcrpe.galenos.2022.2022-12-11] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/24/2022] [Indexed: 01/16/2023] Open
Abstract
Objective Early puberty is development of secondary sex characteristics earlier than the expected normal age range. We subjectively observed an increased frequency of early puberty during the Coronavirus disease-2019 (COVID-19) lockdown and aimed to show the clinical, demographic characteristics of the cases and the change in its incidence. Methods Female patients with central precocious puberty (CPP, n=28) and rapidly progressive early puberty (RPEP, n=61), presenting to our clinic before (January 2019-March 2020) and during the COVID-19 pandemic (April 2020-June 2021) were included. Results Among 28 CPP cases, six (21%) presented before the pandemic lockdown, whereas 22 (79%) were diagnosed during the COVID-19 pandemic lockdown. While RPEP was seen in 16 (26%) patients before the pandemic, 45 (74%) patients were diagnosed during the lockdown period. Presentation with menarche was seen in 15 RPEP patients; two (13%) were in the prepandemic period and 13 (87%) were in the lockdown period. Chronological age, bone age, bone age to chronological age ratio, height, weight, and body mass index standard deviation scores of patients with RPEP and CPP were similar between the prepandemic and pandemic period. Conclusion In this cohort, the frequency of CPP and RPP cases were significantly (p<0.001) increased during the COVID-19 pandemic, possibly due to environmental changes.
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Affiliation(s)
- Kübra Yüksek Acinikli
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - İbrahim Mert Erbaş
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Özge Besci
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Korcan Demir
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ayhan Abacı
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ece Böber
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
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20
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Yesiltepe Mutlu G, Eviz E, Haliloglu B, Kirmizibekmez H, Dursun F, Ozalkak S, Cayir A, Sacli BY, Ozbek MN, Demirbilek H, Hatun S. The effects of the covid-19 pandemic on puberty: a cross-sectional, multicenter study from Turkey. Ital J Pediatr 2022; 48:144. [PMID: 35964090 PMCID: PMC9375063 DOI: 10.1186/s13052-022-01337-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUNDS During the Coronavirus-19 disease (Covid-19) pandemic it was observed that the number of girls presenting with early puberty had increased. The aim of this study was to carry out a retrospective evaluation of the characteristics of girls who had been referred for evaluation of precocious puberty in five different pediatric endocrinology units, before and during the pandemic. METHODS The study participants comprised 359 girls who were assigned into 2 groups a pre-pandemic group (n:214) and a pandemic group (n:145). Those participants (n:99) who had medical records in the follow-up period were classified into 3 subgroups according to the time of presentation and follow-up visits (group-1: first admission and follow-up visit before the pandemic, group-2: first admission before the pandemic, the follow-up visit during the pandemic, group-3: first admission and follow-up visit during the pandemic). RESULTS The age at presentation and age at pubertal onset were both significantly lower in the pandemic group than those in the pre-pandemic group(8.1 vs 8.6, p: < 0.001,7.7 vs 7.9,p:0.013, respectively). There was no significant difference between the body mass index standard deviation scores (BMI-SDS) values of the groups (0.57 vs 0.51, p:0.430). The initiation rate of pubertal suppression therapy at the time of presentation was significantly higher in the pandemic group compared to that of the pre-pandemic group (7.7%vs 27.5%), and in groups-2 & 3 compared to group-1, during follow-up (20%&44%vs 8%). CONCLUSION Our research showed that the onset of puberty occurred earlier in the pandemic period compared to the previous year, and the need for pubertal suppression therapy increased during the pandemic.
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Affiliation(s)
- Gul Yesiltepe Mutlu
- Department of Pediatric Endocrinology and Diabetes, Koç University School of Medicine, Koç Üniversitesi Hastanesi, Davutpaşa Cd. No:4, Topkapı, 34010, Turkey
| | - Elif Eviz
- Department of Pediatric Endocrinology and Diabetes, Koç University School of Medicine, Koç Üniversitesi Hastanesi, Davutpaşa Cd. No:4, Topkapı, 34010, Turkey.
| | - Belma Haliloglu
- Department of Pediatric Endocrinology and Diabetes, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Heves Kirmizibekmez
- Department of Pediatric Endocrinology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Fatma Dursun
- Department of Pediatric Endocrinology, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Servan Ozalkak
- Clinic of Pediatric Endocrinology, University of Health Sciences Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Atilla Cayir
- Department of Pediatric Endocrinology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Beste Yuksel Sacli
- Department of Pediatric Endocrinology and Diabetes, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Mehmet Nuri Ozbek
- Clinic of Pediatric Endocrinology, University of Health Sciences Turkey, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | - Huseyin Demirbilek
- Faculty of Medicine, Department of Pediatric Endocrinology, Hacettepe University, Ankara, Turkey
| | - Sukru Hatun
- Department of Pediatric Endocrinology and Diabetes, Koç University School of Medicine, Koç Üniversitesi Hastanesi, Davutpaşa Cd. No:4, Topkapı, 34010, Turkey
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21
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Gnocchi M, D’Alvano T, Lattanzi C, Messina G, Petraroli M, Patianna VD, Esposito S, Street ME. Current evidence on the impact of the COVID-19 pandemic on paediatric endocrine conditions. Front Endocrinol (Lausanne) 2022; 13:913334. [PMID: 35992140 PMCID: PMC9388786 DOI: 10.3389/fendo.2022.913334] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/18/2022] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory coronavirus 2 (SARS-CoV-2) interacts with the host cells through its spike protein by binding to the membrane enzyme angiotensin-converting enzyme 2 (ACE2) and it can have a direct effect on endocrine function as ACE2 is expressed in many glands and organs with endocrine function. Furthermore, several endocrine conditions have features that might increase the risk of SARS-CoV-2 infection and the severity and course of the infection, as obesity for the underlying chronic increased inflammatory status and metabolic derangement, and for the possible changes in thyroid function. Vitamin D has immunomodulatory effects, and its deficiency has negative effects. Adrenal insufficiency and excess glucocorticoids affect immune conditions also besides metabolism. This review aims to analyze the rationale for the fear of direct effects of SARS-Cov-2 on endocrinological disorders, to study the influence of pre-existing endocrine disorders on the course of the infection, and the actual data in childhood. Currently, data concerning endocrine function during the pandemic are scarce in childhood and for many aspects definite conclusions cannot be drawn, however, data on properly managed patients with adrenal insufficiency at present are re-assuring. Too little attention has been paid to thyroid function and further studies may be helpful. The available data support a need for adequate vitamin D supplementation, caution in obese patients, monitoring of thyroid function in hospitalized patients, and confirm the need for an awareness campaign for the increased frequency of precocious puberty, rapidly progressive puberty and precocious menarche. The changes in lifestyle, the increased incidence of overweight and the change in the timing of puberty lead also to hypothesize that there might be an increase in ovarian dysfunction, as for example polycystic ovarian disease, and metabolic derangements in the next years, and in the future we might be facing fertility problems. This prompts to be cautious and maintain further surveillance.
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Affiliation(s)
| | | | | | | | | | | | | | - Maria E. Street
- Unit of Paediatrics, Department of Medicine and Surgery, University of Parma, and University Hospital of Parma, Parma, Italy
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22
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Mondkar SA, Oza C, Khadilkar V, Shah N, Gondhalekar K, Kajale N, Khadilkar A. Impact of COVID-19 lockdown on idiopathic central precocious puberty - experience from an Indian centre. J Pediatr Endocrinol Metab 2022; 35:895-900. [PMID: 35658967 DOI: 10.1515/jpem-2022-0157] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/17/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Owing to increase in referrals for precocity observed during COVID-19 lockdown, this study was conducted to estimate the proportion of patients referred for precocity and within these, those with idiopathic central precocious puberty (iCPP) before vs. during the COVID lockdown, and to assess the differences in anthropometric and clinical characteristics among iCPP patients in the two groups. METHODS Retrospective study conducted at a tertiary level paediatric endocrinology centre (Western India) evaluating proportion of referrals for precocity and comparing demographics, anthropometry, pubertal staging and bone age at presentation among children with iCPP divided into two groups (pre-lockdown-group 1, lockdown-group 2). RESULTS During lockdown, 155 (5.1%; 146 girls) of 3,053 referrals for precocity as opposed to 59 (1.4%; 54 girls) of 4,208 before the lockdown (p<0.05) were seen; increase was higher in girls (p<0.05). Proportion of referrals for iCPP was significantly higher in the lockdown (4.4%; 136 children vs. 1%; 44 children in group 2) among both genders. Mean age at first visit was 7.8 ± 1.3 and 8.2 ± 1.2 years in groups 1 and 2, respectively. Mean height, weight, BMI and height minus mid-parental height Z scores were not significantly different between the groups. Children in group 2 had a significantly advanced mean bone age (10.7 ± 2 years) and difference in bone and chronological ages (2.5 ± 1.2 years) as compared to group-1 (9.7 ± 1.9; 1.9 ± 1.2) and a larger proportion presented in late puberty. CONCLUSIONS We found an increase in the referrals for precocious puberty and an increase in number of children diagnosed with iCPP during COVID lockdown.
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Affiliation(s)
- Shruti A Mondkar
- Growth and Paediatric Endocrinology Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Chirantap Oza
- Growth and Paediatric Endocrinology Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Growth and Paediatric Endocrinology Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.,Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
| | - Nikhil Shah
- Growth and Paediatric Endocrinology Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.,Department of Pediatrics, Cloudnine Hospital, Mumbai, India
| | - Ketan Gondhalekar
- Growth and Paediatric Endocrinology Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Neha Kajale
- Growth and Paediatric Endocrinology Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Growth and Paediatric Endocrinology Unit, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India.,Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
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23
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de Oliveira Neto CP, Azulay RSDS, de Almeida AGFP, Tavares MDGR, Vaz LHG, Leal IRL, Gama MEA, Ribeiro MRC, Nascimento GC, Magalhães M, dos Santos WC, Facundo AN, Faria MDS, Lago DCF. Differences in Puberty of Girls before and during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4733. [PMID: 35457600 PMCID: PMC9031193 DOI: 10.3390/ijerph19084733] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 11/25/2022]
Abstract
In the COVID-19 pandemic, there was an increase in consultations for precocious puberty. We aim to analyze differences in female puberty before and during the COVID-19 pandemic. A cross-sectional analytical study was designed at the Pediatric Endocrinology Clinic of the University Hospital of the Federal University of Maranhão in São Luis, Brazil. We included 55 girls with precocious puberty, 22 who started puberty during the pandemic and 33 who started puberty before the pandemic. Clinical, anthropometric, laboratory and imaging variables were compared between groups. Statistics were performed to determine if there was a statistical difference between the groups. Girls with puberty during the pandemic had higher Z-scores for weight (1.08 ± 1.29 versus 0.69 ± 0.83; p = 0.04), lower ovarian volume (1.88 ± 0.95 versus 3.15 ± 2.31; p = 0.01), and smaller differences between thelarche noticed by the parents and the diagnosis (6.63 ± 5.21 versus 12.15 ± 9.96; p = 0.02). The association between precocious puberty during the pandemic with higher Z-scores for weight, lower ovarian volume, and a reduction in the time between the perception of pubertal findings by parents and the diagnosis suggests the influence of the pandemic on the normal time of puberty.
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Affiliation(s)
- Clariano Pires de Oliveira Neto
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Postgraduate Program in Health Sciences, Federal University of Maranhão, São Luis 65080-805, Brazil
| | - Rossana Santiago de Sousa Azulay
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
| | - Ana Gregória Ferreira Pereira de Almeida
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
| | - Maria da Glória Rodrigues Tavares
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
| | - Luciana Helena Gama Vaz
- Service of Pediatric Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (L.H.G.V.); (I.R.L.L.)
| | - Ianik Rafaela Lima Leal
- Service of Pediatric Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (L.H.G.V.); (I.R.L.L.)
| | - Monica Elinor Alves Gama
- Department of Medicine III, Federal University of Maranhão, São Luis 65020-240, Brazil; (M.E.A.G.); (M.R.C.R.)
| | | | - Gilvan Cortês Nascimento
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
| | - Marcelo Magalhães
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Clinical Research Center, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil
| | - Wellyandra Costa dos Santos
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Clinical Research Center, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil
| | - Alexandre Nogueira Facundo
- Service of Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (R.S.d.S.A.); (A.G.F.P.d.A.); (M.d.G.R.T.); (G.C.N.); (A.N.F.)
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
| | - Manuel dos Santos Faria
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Postgraduate Program in Health Sciences, Federal University of Maranhão, São Luis 65080-805, Brazil
- Clinical Research Center, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil
| | - Débora Cristina Ferreira Lago
- Research Group in Clinical and Molecular Endocrinology and Metabology (ENDOCLIM), São Luis 65020-070, Brazil; (M.M.); (W.C.d.S.); (M.d.S.F.); (D.C.F.L.)
- Service of Pediatric Endocrinology, University Hospital, Federal University of Maranhão, São Luis 65020-070, Brazil; (L.H.G.V.); (I.R.L.L.)
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Peinkhofer M, Bossini B, Penco A, Giangreco M, Pellegrin MC, Vidonis V, Vittori G, Grassi N, Faleschini E, Barbi E, Tornese G. Reduction in pediatric growth hormone deficiency and increase in central precocious puberty diagnoses during COVID 19 pandemics. Ital J Pediatr 2022; 48:49. [PMID: 35346309 PMCID: PMC8960104 DOI: 10.1186/s13052-022-01238-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 03/08/2022] [Indexed: 01/14/2023] Open
Abstract
Abstract
Background
While several studies have been published so far on the effect of COVID-19 pandemic on health care for non-COVID-19 diseases, to date no study evaluated the impact of the COVID-19 pandemic on the entire field of pediatric endocrinology. This study aimed to evaluate differences in pediatric endocrine stimulation tests after the advent of COVID-19 pandemics.
Methods
Retrospective study with data collection for pediatric endocrine stimulation tests performed in 2019 and 2020 in a tertiary center.
Results
Overall, 251 tests were performed on 190 patients in 2020, compared to 278 tests on 206 patients in 2019 (− 10% tests; − 8% children evaluated). A significant reduction was found in tests to diagnose growth hormone deficiency (GHD) (− 35%), while LHRH tests increased (+ 22%). A reduction of 30% in GHD diagnosis was observed. Central precocious puberty (CPP) diagnosis increased by 38% compared to 2019, mainly in females.
Conclusion
This study found a significant reduction of tests investigating GHD during COVID-19 pandemics. It also showed a clinically meaningful increase in cases of CPP in girls. These results suggest the need for families and pediatricians to monitor children’s growth during isolation and enlighten new perspectives towards conditions associated with lockdown restrictions as increased screen time, social isolation, and children’s anxiety as possible triggers of CPP.
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Choi KH, Park SC. An increasing tendency of precocious puberty among Korean children from the perspective of COVID-19 pandemic effect. Front Pediatr 2022; 10:968511. [PMID: 36090560 PMCID: PMC9454605 DOI: 10.3389/fped.2022.968511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION This study was conducted to investigate changes and new trends over the past 6 years by analyzing the current status of precocious puberty (PP) treatment and treatment costs in Korea between 2016 and 2021. MATERIALS AND METHODS Annual and monthly number of patients diagnosed with PP from 2016 to 2021 were reviewed using the data from Healthcare Bigdata Hub. Annual medical insurance expenses for the treatment of PP were also reviewed. The data were compared by the gender of the patients. RESULTS The number of patients diagnosed with PP rose from 86,352 in 2016 to 166,645 in 2021, while medical expenses rose from KRW 64,111,689,000 in 2016 to KRW 134,642,100,000 in 2021. The percentage of male PP patients increased from 9.21% in 2016 to 19.55% in 2021. CONCLUSION Increasing numbers of Korean patients diagnosed with PP. Consistent with the situation in other countries, the rapid increase in the number of cases since April 2020 appears to be a result of the COVID-19 pandemic. In Korea, this is considered a nationwide phenomenon. Also on the rise is the incidence of PP in males, which appears to be due to an increased awareness of the phenomenon. Further investigations are required to determine the possible causes in increasing prevalence of PP.
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Prosperi S, Chiarelli F. Early and precocious puberty during the COVID-19 pandemic. Front Endocrinol (Lausanne) 2022; 13:1107911. [PMID: 36699035 PMCID: PMC9868951 DOI: 10.3389/fendo.2022.1107911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
During the year 2020, the COVID-19 pandemic rapidly became a severe health emergency worldwide. In order to contrast the spread of the novel SARS-CoV-2, many countries implemented extraordinary restrictive measures, such as a strict lockdown and school closures. The pandemic had a great impact on children and adolescents' daily life, leading to a much more sedentary lifestyle, to larger use of electronic devices and to an increase in stress-related symptoms. These conspicuous changes acted as disruptors of children's normal development. Since the beginning of the pandemic, many studies reported an increase in the number of precocious puberty cases as well as a faster progression rate of puberty itself, if compared to the pre-pandemic years. In this review, our aim was to evaluate the incidence of new cases of early and precocious puberty during the COVID-19 pandemic, analyzing variations in the timing of puberty and in pubertal progression rate, and to investigate the role of environmental and lifestyle factors during the pandemic in modulating the physiopathology of pubertal development. While a direct effect of SARS-CoV-2 infection remains, at the moment, a remote hypothesis, both physical and psychological factors related to the pandemic seem to have a role in triggering GnRH pulsatile secretion leading to earlier pubertal onset. It is indeed important to stress the need to clarify the exact role of COVID-19 in early pubertal onset comparing data from all over the world; long-term comprehensive studies are also pivotal to explain whether this phenomenon will continue while we resume pre-pandemic habits.
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