Etiology and frequency of precocious pubertal development in children treated at the Department of Pediatrics University Hospital Center Zagreb from 2009 to 2019

UVOD: Preuranjeni pubertet (PP) definiramo početkom razvoja sekundarnih spolnih oznaka prije osme godine u djevojčica i devete godine u dječaka. Sekularni trend snižavanja dobi početka puberteta dovodi do porasta broja djece upućene na obradu zbog sumnje na PP. ----- CILJ: Ispitati etiologiju preuranjenog pubertetskog razvoja u bolesnika liječenih u Klinici za pedijatriju KBC Zagreb te ispitati kliničke, biokemijske i radiološke osobine djece s pravim preuranjenim pubertetom (CPP). METODE: Retrospektivna analiza podataka iz medicinske dokumentacije pacijenata liječenih u Klinici u razdoblju 2009. – 2019. godine koji se vode pod dijagnozom PP-a. ----- REZULTATI: Od ukupno 680 pacijenata upućenih na obradu zbog sumnje na PP, u 184 (27,1 %) postavljena je dijagnoza CPP-a. Učestalost CPP-a 15,7 puta je veća u djevojčica nego u dječaka. Najčešći vodeći simptom u djevojčica je povećanje dojki (83,1 %), dok je u dječaka razvoj pubične dlakavosti (100 %). Pacijenti sa CPP-om imaju ubrzanje rasta i veći prirast na tjelesnoj težini u odnosu na vršnjake te je 41,7 % pacijenata bilo visinom iznad 95.percentile, a indeks tjelesne težine iznad 95. percentile imalo je njih 20,2 %. Povišenu bazalnu koncentraciju LH-a (> 0,3 IU/l) imalo je 51,6 % pacijenata. Koštana dob pacijenata odstupala je za +2,0 ± 1,2 godine od kronološke. Prevalencija patološkog nalaza MR-a HH regije bila je veća u dječaka (40 %) nego u djevojčica (19,6 %). Liječenje GnRH analogom provedeno je u 58,2 % pacijenata. ----- ZAKLJUČAK: Učestalost preuranjenog pubertetskog razvoja je u porastu što zahtijeva bolju informiranost zdravstvenih djelatnika i rano prepoznavanje. Praćenjem bolesnika i dijagnostičkom obradom potrebno je utvrditi etiologiju CPP-a te izdvojiti bolesnike u kojih je indicirano liječenje.INTRODUCTION: Precocious puberty refers to the appearance of secondary sex characteristics before age 8 in girls and age 9 in boys. Secular trend of earlier pubertal onset has led to an increase in the number of children referred for evaluation of precocious puberty (PP). ----- AIM: To determine the etiology of premature pubertal development in patients treated at the Department of Pediatrics, University Hospital Centre Zagreb and to examine the clinical, biochemical and radiological characteristics of children with central precocious puberty (CPP). ----- METHODS: Retrospective analysis of medical records of patients treated at the Clinic during the period 2009 – 2019 with the diagnosis of PP. ----- RESULTS: Among 680 patients referred to treatment due to an indication of PP, 184 (27.1%) were diagnosed with CPP. The CPP’s frequency is 15.7 times higher in girls than in boys. The most common initial symptom in girls is breast augmentation (83.1%) and in boys development of pubic hair (100%). CPP patients have accelerated growth and higher weight gain compared to their peers and therefore 41.7% of patients had a height above the 95th percentile, while the body mass index above the 95th percentile was present in 20.2% of patients. Elevated basal concentration of LH (> 0.3 IU/l) was found in 51.6% of patients. The bone age advancement was +2.0 ± 1.2 years in our study group. Prevalence of pathological findings on MR HH region was higher in boys (40%) than in girls (19.6%). Treatment with GnRH analogue was performed in 58.2% of patients. ----- CONCLUSION: The incidence of premature pubertal development is increasing, requiring better awareness of medical professionals and early recognition. The patients’ evaluation and follow-up enables appropriate diagnosis and selection of patients with CPP requiring therapy