Covid-19 Research

Research Article

Increase of Consultations for Premature Thelarche and the Post-Diagnostic of Precocious and Accelerated Puberty in Pediatric Endocrinology in Alava, due to the Confinement Measures Endured in 2019 due to the COVID-19 Pandemic

Journal of Biomedical Research & Environmental Sciences article abstract with citation details, DOI, publication dates, subject areas, full text links, and references.

View DOI Submit Manuscript

Article Details

Publication record, authors, dates, abstract, and full text access.

Open Access
Article Type Research Article
Subject Medicine Group
OCLC JBRES Record
Leyre Aurora Vilella San Martin*, Ignacio Diez Lopez, Amaia San Martu00edn Orayen, Sandra Maeso Mendez and Ainhoa Sarasua Miranda
Issue: Volume3-Issue11
Pages: 1374-1381
Received: 2022-11-11
Accepted: 2022-11-21
Published: 2022-11-22

Abstract

Introduction: Due to the COVID 19 pandemic and home confinement measures, many of our routine and daily habits have been both affected and modified. Have these factors conditioned a real increase in Precocious (PP) and Accelerated Puberty (AP)?

Objectives: This is an observational and retrospective study in which the incidence of medical consultations due to Premature Thelarche is compared between March to December 2019 and 2020. The medical consultations occurred in the Pediatric Endocrinology (PE) consultation of our hospital.
Patients and Methods: The analysis involved 75 cases of young girls consulted with Premature Thelarche in 2019 and 97 girls which were consulted in 2020. From each patient different variables were analyzed, such as somatometry, hormones, eco and treatment.

Results: In 2019, 75 first visits of PE were due to Premature Thelarche in young girls (accounting for 2.46% of the total number of first visits carried out in Pediatrics Outpatient Clinics (POC) and 16.77% of PE first visits). However, in 2020, 97 first visits were due to PE (3.52% the total first time visits of OC and 23.3% in PE). It was found that, in 2020 the number of first time visits due to Premature Thelarche increased by 28% compared to 2019 (p = 0.0001 mean comparison).
In 2019, out of the 75 consultations due to premature Thelarche, 40% were diagnosed with an earlier physiological puberty. Conversely in 2020, out of the 97 consultations, 61.77% had a normal physiological puberty. These figures represent an OR of 1.54 (p = 0.02 t Student for independent samples). It was evaluated whether the patients had experienced > 3 kg weight gain above 6 months prior to the medical visit. In 2020, 31.57% of patients experienced weight gain, whereas 68.42% did not. In 2019 patients who experienced weight gain accounted for 12.16% and 87.83% did not experience significant weight gain (p = 0.01 t Student for independent samples).

Conclusion: Our data demonstrates there has been an increase in the incidence of the referrals from Primary Attention to Pediatric Endocrinology to examine advanced Thelarche during the period of lockdown measures (2020), in addition to an increase in the number of diagnostics of PP and AP in young girls in our hospital when compared to figures of 2019. Furthermore, in 2020 there was a greater number of patients who experienced weight gain increase 6 months prior to the medical consultations.

We hypothesize that lockdown inflicted sedentary lifestyles together with changes in dietary habits, promoting weight gain in patients. This effect could have caused a body fat mass increase in girls, suggesting a “trigger effect” in the activation of the gonadal axis, causing a rise in the number of early puberty cases.

FullText HTML FullText PDF DOI: 10.37871/jbres1606 Crossmark

Certificate of Publication

Certificate of Publication

Copyright

© 2022 San Martin LAV, et al. Distributed under Creative Commons CC-BY 4.0 Creative CommonsAttribution

How to cite this article

San Martin LAV, Lopez ID, Martín Orayen AS, Mendez SM, Miranda AS. Increase of Consultations for Premature Thelarche and the Post-Diagnostic of Precocious and Accelerated Puberty in Pediatric Endocrinology in Alava, due to the Confinement Measures Endured in 2019 due to the COVID-19 Pandemic. 2022 Nov 22; 3(11): 1374-1381. doi: 10.37871/jbres1606, Article ID: JBRES1606, Available at: https://www.jelsciences.com/articles/jbres1606.pdf

Subject area(s)

Clinical Endocrinology

References

  1. Brito VN, Latronico AC. Puberty: when is it normal? Arch Endocrinol Metab. 2015 Apr;59(2):93-4. doi: 10.1590/2359-3997000000018. Epub 2015 Apr 1. PMID: 25993668.
  2. Feibelmann TC, Silva AP, Resende DC, Resende EA, Scatena LM, Borges Mde F. Puberty in a sample of Brazilian schoolgirls: timing and anthropometric characteristics. Arch Endocrinol Metab. 2015 Apr;59(2):105-11. doi: 10.1590/2359-3997000000021. Epub 2015 Apr 1. PMID: 25993671.
  3. Khan L. Puberty: Onset and Progression. Pediatr Ann. 2019 Apr 1;48(4):e141-e145. doi: 10.3928/19382359-20190322-01. PMID: 30986314.
  4. Brito VN, Spinola-Castro AM, Kochi C, Kopacek C, Silva PC, Guerra-Júnior G. Central precocious puberty: revisiting the diagnosis and therapeutic management. Arch Endocrinol Metab. 2016 Apr;60(2):163-72. doi: 10.1590/2359-3997000000144. Erratum in: Arch Endocrinol Metab. 2016 Aug;60(4):407. PMID: 27191050.
  5. Reinehr T, Roth CL. Is there a causal relationship between obesity and puberty? Lancet Child Adolesc Health. 2019 Jan;3(1):44-54. doi: 10.1016/S2352-4642(18)30306-7. Epub 2018 Nov 14. PMID: 30446301.
  6. Stagi S, De Masi S, Bencini E, Losi S, Paci S, Parpagnoli M, Ricci F, Ciofi D, Azzari C. Increased incidence of precocious and accelerated puberty in females during and after the Italian lockdown for the coronavirus 2019 (COVID-19) pandemic. Ital J Pediatr. 2020 Nov 4;46(1):165. doi: 10.1186/s13052-020-00931-3. PMID: 33148304; PMCID: PMC7609833.
  7. Durand A, Bashamboo A, McElreavey K, Brauner R. Familial early puberty: presentation and inheritance pattern in 139 families. BMC Endocr Disord. 2016 Sep 13;16(1):50. doi: 10.1186/s12902-016-0130-x. PMID: 27624871; PMCID: PMC5022170.
  8. Kim YJ, Kwon A, Jung MK, Kim KE, Suh J, Chae HW, Kim DH, Ha S, Seo GH, Kim HS. Incidence and Prevalence of Central Precocious Puberty in Korea: An Epidemiologic Study Based on a National Database. J Pediatr. 2019 May;208:221-228. doi: 10.1016/j.jpeds.2018.12.022. Epub 2019 Mar 8. PMID: 30857777.
  9. Bräuner EV, Busch AS, Eckert-Lind C, Koch T, Hickey M, Juul A. Trends in the Incidence of Central Precocious Puberty and Normal Variant Puberty Among Children in Denmark, 1998 to 2017. JAMA Netw Open. 2020 Oct 1;3(10):e2015665. doi: 10.1001/jamanetworkopen.2020.15665. PMID: 33044548; PMCID: PMC7550972.
  10. Eckert-Lind C, Busch AS, Petersen JH, Biro FM, Butler G, Bräuner EV, Juul A. Worldwide Secular Trends in Age at Pubertal Onset Assessed by Breast Development Among Girls: A Systematic Review and Meta-analysis. JAMA Pediatr. 2020 Apr 1;174(4):e195881. doi: 10.1001/jamapediatrics.2019.5881. Epub 2020 Apr 6. PMID: 32040143; PMCID: PMC7042934.
  11. Abreu AP, Macedo DB, Brito VN, Kaiser UB, Latronico AC. A new pathway in the control of the initiation of puberty: the MKRN3 gene. J Mol Endocrinol. 2015 Jun;54(3):R131-9. doi: 10.1530/JME-14-0315. PMID: 25957321; PMCID: PMC4573396.
  12. Sultan C, Gaspari L, Maimoun L, Kalfa N, Paris F. Disorders of puberty. Best Pract Res Clin Obstet Gynaecol. 2018 Apr;48:62-89. doi: 10.1016/j.bpobgyn.2017.11.004. Epub 2017 Nov 14. PMID: 29422239.
  13. Kaplowitz P, Bloch C; Section on Endocrinology, American Academy of Pediatrics. Evaluation and Referral of Children With Signs of Early Puberty. Pediatrics. 2016 Jan;137(1). doi: 10.1542/peds.2015-3732. Epub 2015 Dec 14. PMID: 26668298.
  14. Martins WP, Nastri CO. Ultrasonographic measurement of ovarian volume in the diagnosis of central precocious puberty. Ultrasound Obstet Gynecol. 2009 Oct;34(4):484-5. doi: 10.1002/uog.7355. PMID: 19790095.
  15. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020 Feb 15;395(10223):470-473. doi: 10.1016/S0140-6736(20)30185-9. Epub 2020 Jan 24. Erratum in: Lancet. 2020 Jan 29;: PMID: 31986257; PMCID: PMC7135038.
  16. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KSM, Lau EHY, Wong JY, Xing X, Xiang N, Wu Y, Li C, Chen Q, Li D, Liu T, Zhao J, Liu M, Tu W, Chen C, Jin L, Yang R, Wang Q, Zhou S, Wang R, Liu H, Luo Y, Liu Y, Shao G, Li H, Tao Z, Yang Y, Deng Z, Liu B, Ma Z, Zhang Y, Shi G, Lam TTY, Wu JT, Gao GF, Cowling BJ, Yang B, Leung GM, Feng Z. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020 Mar 26;382(13):1199-1207. doi: 10.1056/NEJMoa2001316. Epub 2020 Jan 29. PMID: 31995857; PMCID: PMC7121484.
  17. Verzani M, Bizzarri C, Chioma L, Bottaro G, Pedicelli S, Cappa M. "Impact of COVID-19 pandemic lockdown on early onset of puberty: experience of an Italian tertiary center". Ital J Pediatr. 2021 Mar 5;47(1):52. doi: 10.1186/s13052-021-01015-6. PMID: 33673836; PMCID: PMC7935003.
  18. Bradley SH, Lawrence N, Steele C, Mohamed Z. Precocious puberty. BMJ. 2020 Jan 13;368:l6597. doi: 10.1136/bmj.l6597. PMID: 31932347.
  19. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006 Apr;450:76-85. doi: 10.1111/j.1651-2227.2006.tb02378.x. PMID: 16817681.
  20. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969 Jun;44(235):291-303. doi: 10.1136/adc.44.235.291. PMID: 5785179; PMCID: PMC2020314.
  21. Reynolds E. Radiographic Atlas of Skeletal Development of the Hand and Wrist. Greulich WW, Pyle SI, editors. Redwood City, CA, USA: Stanford University Press; 1950;8:518-520.
  22. Dorn LD, Susman EJ, Nottelmann ED, Chrousos GP. Perceptions of puberty: Adolescent and parent ratings of pubertal stage. Pediatric Res. 1987;21:173.
  23. Street ME, Sartori C, Catellani C, Righi B. Precocious Puberty and Covid-19 Into Perspective: Potential Increased Frequency, Possible Causes, and a Potential Emergency to Be Addressed. Front Pediatr. 2021 Sep 20;9:734899. doi: 10.3389/fped.2021.734899. PMID: 34616700; PMCID: PMC8488256.
  24. Karpati AM, Rubin CH, Kieszak SM, Marcus M, Troiano RP. Stature and pubertal stage assessment in American boys: the 1988-1994 Third National Health and Nutrition Examination Survey. J Adolesc Health. 2002 Mar;30(3):205-12. doi: 10.1016/s1054-139x(01)00320-2. PMID: 11869928.
  25. Yackobovitch-Gavan M, Fisch Shvalb N, Bhutta ZA. Malnutrition and Catch-Up Growth during Childhood and Puperty. World Rev Nutr Diet. 2019;120:158-180. doi: 10.1159/000503646. Epub 2020 Jan 28. PMID: 33502356.
  26. Li W, Liu Q, Deng X, Chen Y, Liu S, Story M. Association between Obesity and Puberty Timing: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2017 Oct 24;14(10):1266. doi: 10.3390/ijerph14101266. PMID: 29064384; PMCID: PMC5664767.
  27. Sedlak P, Pařízková J, Samešová D, Musálek M, Dvořáková H, Novák J. Secular Changes in Body Build and Body Composition in Czech Preschool Children in the Context of Latent Obesity. Children (Basel). 2020 Dec 31;8(1):18. doi: 10.3390/children8010018. PMID: 33396305; PMCID: PMC7823761.
  28. Huber BC, Steffen J, Schlichtiger J, Brunner S. Altered nutrition behavior during COVID-19 pandemic lockdown in young adults. Eur J Nutr. 2021 Aug;60(5):2593-2602. doi: 10.1007/s00394-020-02435-6. Epub 2020 Dec 1. PMID: 33258996; PMCID: PMC7705857.
  29. Teixeira MT, Vitorino RS, da Silva JH, Raposo LM, Aquino LA, Ribas SA. Eating habits of children and adolescents during the COVID-19 pandemic: The impact of social isolation. J Hum Nutr Diet. 2021 Aug;34(4):670-678. doi: 10.1111/jhn.12901. Epub 2021 Apr 26. PMID: 33811690; PMCID: PMC8251498.
  30. Füzéki E, Schröder J, Carraro N, Merlo L, Reer R, Groneberg DA, Banzer W. Physical Activity during the First COVID-19-Related Lockdown in Italy. Int J Environ Res Public Health. 2021 Mar 3;18(5):2511. doi: 10.3390/ijerph18052511. PMID: 33802549; PMCID: PMC7967499.
  31. Chioma L, Bizzarri C, Verzani M, Fava D, Salerno M, Capalbo D, Guzzetti C, Penta L, Di Luigi L, di Iorgi N, Maghnie M, Loche S, Cappa M. Sedentary lifestyle and precocious puberty in girls during the COVID-19 pandemic: an Italian experience. Endocr Connect. 2022 Feb 14;11(2):e210650. doi: 10.1530/EC-21-0650. PMID: 35029543; PMCID: PMC8859940.
  32. Wagner IV, Sabin MA, Pfäffle RW, Hiemisch A, Sergeyev E, Körner A, Kiess W. Effects of obesity on human sexual development. Nat Rev Endocrinol. 2012 Jan 31;8(4):246-54. doi: 10.1038/nrendo.2011.241. PMID: 22290357.
  33. Kang MJ, Oh YJ, Shim YS, Baek JW, Yang S, Hwang IT. The usefulness of circulating levels of leptin, kisspeptin, and neurokinin B in obese girls with precocious puberty. Gynecol Endocrinol. 2018 Jul;34(7):627-630. doi: 10.1080/09513590.2017.1423467. Epub 2018 Jan 5. PMID: 29303010.
  34. El-Eshmawy MM, Abdel Aal IA, El Hawary AK. Association of ghrelin and leptin with reproductive hormones in constitutional delay of growth and puberty. Reprod Biol Endocrinol. 2010 Dec 22;8:153. doi: 10.1186/1477-7827-8-153. PMID: 21176234; PMCID: PMC3022842.
  35. Chen Y, Chen J, Tang Y, Zhang Q, Wang Y, Li Q, Li X, Weng Z, Huang J, Wang X, Liu S. Difference of Precocious Puberty Between Before and During the COVID-19 Pandemic: A Cross-Sectional Study Among Shanghai School-Aged Girls. Front Endocrinol (Lausanne). 2022 Mar 21;13:839895. doi: 10.3389/fendo.2022.839895. PMID: 35392135; PMCID: PMC8979840.
  36. Chen C, Zhang Y, Sun W, Chen Y, Jiang Y, Song Y, Lin Q, Zhu L, Zhu Q, Wang X, Liu S, Jiang F. Investigating the relationship between precocious puberty and obesity: a cross-sectional study in Shanghai, China. BMJ Open. 2017 Apr 11;7(4):e014004. doi: 10.1136/bmjopen-2016-014004. Erratum in: BMJ Open. 2017 Aug 23;7(8):e014004corr1. PMID: 28400459; PMCID: PMC5566589.
  37. Jasik CB, Lustig RH. Adolescent obesity and puberty: the "perfect storm". Ann N Y Acad Sci. 2008;1135:265-79. doi: 10.1196/annals.1429.009. PMID: 18574233.
  38. Nagu P, Parashar A, Behl T, Mehta V. CNS implications of COVID-19: a comprehensive review. Rev Neurosci. 2020 Dec 7;32(2):219-234. doi: 10.1515/revneuro-2020-0070. PMID: 33550782.
  39. Naulé L, Maione L, Kaiser UB. Puberty, A Sensitive Window of Hypothalamic Development and Plasticity. Endocrinology. 2021 Jan 1;162(1):bqaa209. doi: 10.1210/endocr/bqaa209. PMID: 33175140; PMCID: PMC7733306.
  40. Fudvoye J, Lopez-Rodriguez D, Franssen D, Parent AS. Endocrine disrupters and possible contribution to pubertal changes. Best Pract Res Clin Endocrinol Metab. 2019 Jun;33(3):101300. doi: 10.1016/j.beem.2019.101300. Epub 2019 Jul 27. PMID: 31401055.
  41. Papadimitriou A, Papadimitriou DT. Endocrine-Disrupting Chemicals and Early Puberty in Girls. Children (Basel). 2021 Jun 10;8(6):492. doi: 10.3390/children8060492. PMID: 34200537; PMCID: PMC8226958.
  42. Stagi S, Ferrari M, Paiusco G, Moriondo M, Azzari C. Possible role of melatonin in precocious and accelerated puberty in females during the COVID-19 pandemic. Ital J Pediatrics. Preprint. 2021.
  43. Gallè F, Sabella EA, Ferracuti S, De Giglio O, Caggiano G, Protano C, Valeriani F, Parisi EA, Valerio G, Liguori G, Montagna MT, Romano Spica V, Da Molin G, Orsi GB, Napoli C. Sedentary Behaviors and Physical Activity of Italian Undergraduate Students during Lockdown at the Time of CoViD-19 Pandemic. Int J Environ Res Public Health. 2020 Aug 25;17(17):6171. doi: 10.3390/ijerph17176171. PMID: 32854414; PMCID: PMC7504707.
  44. Benedetto M, Alonso W, Eyman A, Perez L, Terrasa SA. Pubertad precoz en niñas: potencial impacto de la pandemia y el confinamiento por COVID-19. Evidencia, actualizacion en la práctica ambulatoria. 2021. doi: 10.51987/EVIDENCE.V24I4.6974
  45. Ariza Jimenez AB, Aguilar Gomez-Cardenas FJ, de la Camara Moraño C. Probable impacto de la COVID-19 sobre las derivaciones a endocrinología infantil: aumento de incidencia de pubertad precoz en un hospital de tercer nivel [Likely impact of COVID-19 on referrals to pediatric endocrinology: Increased incidence of precocious puberty in a third-level hospital]. Endocrinol Diabetes Nutr. 2022 Aug-Sep;69(7):542-544. Spanish. doi: 10.1016/j.endinu.2021.09.004. Epub 2021 Oct 6. PMID: 34632288; PMCID: PMC8492601.
Publish with JBRES — Peer-reviewed, multidisciplinary Open Access with rapid review, DOI, and global visibility.
Double-Blind CrossRef DOI Discoverable
Submit Manuscript Membership