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. 2016:2016:4.
doi: 10.1186/s13633-016-0022-x. Epub 2016 Feb 22.

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

Mia Elbek Sømod #  1 , Esben Thyssen Vestergaard #  2   3 , Kurt Kristensen  1 , Niels Holtum Birkebæk  1
Affiliations

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

Mia Elbek Sømod et al. Int J Pediatr Endocrinol. 2016.

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.

Keywords: Gonadotropins; Incidence; Precocious puberty; Premature thelarche; Sex hormone binding globulin.

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Figures

Fig. 1
Fig. 1
Incidence of precocious puberty and premature thelarche expressed as an incidence rate and defined as: No.ofgirlswhogotadiagnosisofPPorPTinacertainyearTotalno.ofgirls1/2−7yearslivingintheregion
Fig. 2
Fig. 2
Number of girls with precocious puberty (PP) and premature thelarche (PT) in the age groups ½-7 years
Fig. 3
Fig. 3
Gonadotropin releasing hormone stimulated luteinizing hormone (LH) in girls with precocious puberty (PP) and premature thelarche (PT) in the age groups ½-7 years
Fig. 4
Fig. 4
Gonadotropin releasing hormone stimulated follicle stimulating hormone (FSH) in girls with precocious puberty (PP) and premature thelarche (PT) in the age groups ½-7 years
Fig. 5
Fig. 5
Gonadotropin releasing hormone stimulated LH/FSH ratio in the age groups ½-7 years
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