Etiology of Increased Referrals for Evaluation of Early Puberty in a Tertiary Care Center in Turkey: True Precocious Puberty, Obesity, or Parental Anxiety and Lack of Knowledge?

Abstract

There has been a global increase in pediatric endocrinology referrals for the concerns of early puberty. The objective of this study was to determine the reasons behind this increase. A retrospective cross-sectional study was designed to analyze the clinical characteristics of patients seen for the concerns of early puberty in pediatric endocrinology clinic of a tertiary care center (Study A). Additionally, a prospective questionnaire study was designed to assess the knowledge and concerns of the mothers regarding the timing of puberty in girls (Study B). In study A, of the 305 girls, 42.9% were overweight/obese, 68.5% either had normal pubertal development for age or were prepubertal, 1 had non-classic congenital adrenal hyperplasia, and 2 had central precocious puberty. Of the 36 boys, 56% were overweight/obese, 64% either had normal pubertal development for age or were prepubertal, and 1 had non-classic congenital adrenal hyperplasia. In study B, 95% of the participants thought the girls have been developing earlier, over 10% considered the first sign of puberty to be normal after the age 14 years and 12.4% considered menarche to be normal after age 14 years. The common sources of anxiety for the participants regarding the earlier timing of puberty were psychosocial issues and short final height. In conclusion, many parents had wrong beliefs/information about the normal timing of puberty and were concerned about precocious puberty in girls. Education of parents about the normal timing of puberty may help avoiding unnecessary referrals, parental anxiety, and financial burden to the society.

Keywords: education; obesity; precocious puberty.

Figure 1.

Study B. The participant mothers were asked to mark the factor or factors that they believe might be causing earlier onset of pubertal maturation in girls using the questionnaire (Supplemental Material 1). The columns were marked as A: Hormones and additives in foods consumed, B: Environmental pollution, C: Computers, TV, and electronic media, and D: Obesity. The responses are depicted in percentages for each factor marked.

Figure 2.

Study B. The participants were asked to mark the reason or reasons for their concerns about the early onset of puberty in girl using the questionnaire (Supplemental Material 1). The columns were marked as A: may end up being a short adult, B: may not enjoy her childhood, C: may experience psychosocial issues, and D: may have an underlying illness. The responses are depicted in percentages for each reason marked.