medwireNews: Researchers suggest that obesity could be a factor triggering some girls with premature thelarche to develop precocious or rapidly progressive puberty.

The team found that the majority of patients in their study who progressed were older than 2 years of age when their symptoms first appeared, and that these patients had a significantly higher BMI than those who developed their symptoms at a younger age.

The study included 158 girls who had breast development before the age of 8 years. The research team divided them into those whose symptoms appeared within 1 month of birth (n=12), between the ages of 1 and 24 months (n=40), and when older than 24 months (n=106).

As in previous studies, symptom duration at the point of diagnosis was longer for the younger children, at an average of 15.4 months among those whose symptoms appeared within a month of birth, compared with just 3.2 months among those whose symptoms developed when they were older than 24 months.

“This suggests that breast development is perceived to be more physiological within the first 2 years of age by parents, resulting in a delay in seeking medical attention”, say Senay Savas-Erdeve (Children’s Health and Disease Training and Research Hospital, Ankara, Turkey) and study co-authors.

By the end of follow-up, thelarche was regressive in 24.7% of the patients, persistent in 32.9%, progressive in 25.9% and cyclic in 16.5%, although the proportions varied according to age at symptom onset. In total, 29.7% of the patients developed central precocious or rapidly progressive puberty, but only 4.2% to 6.3% of these children had developed thelarche symptoms within 24 months of birth, with 89.3% having developed symptoms at an older age.

As well as being older, patients who developed precocious or rapidly progressive puberty were also heavier than those who did not – they had a significantly higher bodyweight standard deviation score (SDS) and a higher BMI SDS.

In total, 24.0% of all the patients were overweight and 8.8% were obese, and a respective 81.6% and 92.9% of these fell into the oldest age category for symptom onset.

These findings imply that increased weight “could stimulate rapidly progressive puberty in cases with premature thelarche”, write the researchers in the Journal of Pediatric Endocrinology and Metabolism.

Height SDS and the ratio of bone age to chronological age did not differ according to whether patients progressed to puberty until the researchers subdivided the group that did progress, showing that girls with central precocious puberty had significant increases for both of these measures.

Eleanor McDermid

J Pediatr Endocrinol Metab 2018; Advance online publication

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