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      Síntesis de la evidencia Translated title: Synthesis of the evidence: Clinical guideline for the diagnosis and treatment of precocious puberty

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      , , , , , , , , , , , , , , , , , , , , , , , ,
      Boletín médico del Hospital Infantil de México
      Instituto Nacional de Salud, Hospital Infantil de México Federico Gómez
      Precocious puberty, Treatment, Diagnosis, Systematic review, Pubertad precoz, Tratamiento, Diagnóstico, Revisión sistemática

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          Abstract

          Resumen Se realizaron tres revisiones sistemáticas para la formulación de las recomendaciones sobre diagnóstico, tratamiento y seguimiento de pacientes con pubertad precoz: intervenciones para el tratamiento de la pubertad precoz que incluyeran los desenlaces de talla final o casi final, salud mental, salud metabólica, salud ósea o éxito en el bloqueo; estudios observacionales comparativos que evaluaran desenlaces a largo plazo en sujetos con antecedentes de pubertad precoz; y por último, estudios de exactitud de prueba diagnóstica para pubertad.

          Translated abstract

          Abstract Three systematic reviews were conducted to formulate the recommendations on diagnosis, treatment and follow-up of patients with precocious puberty: interventions for the treatment of precocious puberty that included the outcomes of final or near-final height, mental health, metabolic health, health bone, or blockade success; comparative observational studies evaluating long-term outcomes in subjects with a history of precocious puberty; and diagnostic test accuracy studies for puberty.

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          Most cited references67

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          Outcomes of early pubertal timing in young women: a prospective population-based study.

          Early pubertal timing in girls is associated with psychosocial problems throughout adolescence, but it is unclear whether these problems persist into young adulthood. The authors analyzed outcomes in adolescence and young adulthood in girls in a longitudinal study. The data for this study were from the prospective population-based Great Smoky Mountains Study (N=1,420), which initially recruited children at ages 9, 11, and 13 and followed them into young adulthood. Pubertal timing was defined on the basis of self-reported Tanner stage and age at menarche. Outcome measures included functioning related to crime, substance use, school/peer problems, family relationships, sexual behavior, and mental health in adolescence (ages 13 to 16) as well as crime, substance use, education/socioeconomic status, sexual behavior, and mental health in young adulthood (ages 19 and 21). In adolescence, early-maturing girls displayed higher levels of self-reported criminality, substance use problems, social isolation, early sexual behavior, and psychiatric problems. By young adulthood, most of these differences had attenuated. Functioning for early maturers improved in some areas; in others, on-time and late maturers had caught up with their early-maturing peers. Nevertheless, early-maturing girls, particularly those with a history of adolescent conduct disorder, were more likely to be depressed in young adulthood compared to their counterparts. Early maturers were also more likely to have had many sexual partners. The effects of early pubertal timing on adolescent psychosocial problems were wide ranging but diminished by young adulthood for all but a small group.
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            Ultrasonographic and clinical parameters for early differentiation between precocious puberty and premature thelarche.

            To determine if uterine and ovarian measurements can significantly distinguish between precocious puberty (PP) and premature thelarche (PT) and whether ultrasound has any advantage over the gonadotropin-releasing hormone (GnRH) stimulation test. Prospective. One hundred and three girls referred consecutively for evaluation of breast budding before age 8 years underwent physical examination, GnRH stimulation test, bone age assessment, and transabdominal pelvic ultrasound. The diagnosis of PP or PT was based on clinical judgment. The clinical, laboratory, and ultrasound data of the PP and PT groups were compared. Eighty-one girls were diagnosed with PP and 22 with PT. Significant differences in most of the uterine and ovarian measurements were found between the groups. On logistic regression analysis, bone age standard deviation score, uterine transverse diameter, and uterine volume were the most significant variables predicting PP. Comparison of 30 girls with PP and 21 with PT in whom peak luteinizing hormone was <5 mIU/ml on the GnRH stimulation test, using analysis of variance, yielded significant differences in uterine width (P<0.001), fundus diameter (P <0.04), uterine volume (P= 0.006), and ovarian circumference (P <0.02). Increased uterine and ovarian measurements may be an early and sensitive sign of PP. Pelvic ultrasound, a noninvasive, inexpensive, and reliable tool, may give the clinician a complementary indication to the GnRH test in distinguishing isolated PT from early-stage PP in girls with early breast budding.
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              Diagnostic value of fluorometric assays in the evaluation of precocious puberty.

              To establish normative data and determine the value of fluorometric AutoDELFIA assays (Wallac Oy) in the investigation of precocious puberty, we determined serum levels of LH, FSH, testosterone, and estradiol under basal and GnRH-stimulated conditions in 277 normal subjects at various pubertal stages and in 77 patients with precocious puberty. A substantial overlap was observed in basal and GnRH-stimulated gonadotropin levels in normal individuals of both sexes with pubertal Tanner stages 1 and 2. The 95th percentile of the normal prepubertal population was the cut-off limit between prepubertal and pubertal levels. These limits were 0.6 IU/L in both sexes for basal LH, 9.6 IU/L in boys and 6.9 IU/L in girls for peak LH after GnRH stimulation, 19 ng/dL in boys for basal testosterone, and 13.6 pg/mL in girls for basal estradiol. Basal and peak LH exceeding these limits were considered positive tests for the diagnosis of gonadotropin-dependent precocious puberty. According to these criteria, the sensitivities of basal and peak LH for the latter diagnosis were 71.4% and 100% in boys, and 62.7% and 92.2% in girls. The specificity and positive predicted value were 100% in both sexes for basal and peak LH levels. The negative predicted values for basal and peak LH were 62.5% and 100% in boys, and 40.6% and 76.5% in girls. Basal and GnRH-stimulated FSH levels overlapped among the various pubertal stages in normal subjects and were, in general, not helpful in the differential diagnosis of precocious puberty. In conclusion, basal LH levels were sufficient to establish the diagnosis of gonadotropin-dependent precocious puberty in 71.4% of boys and 62.7% of girls. In the remaining patients, a GnRH stimulation test was still necessary to confirm this diagnosis. Finally, suppressed LH and FSH levels after GnRH stimulation indicate gonadotropin-independent sexual steroid production.
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                Author and article information

                Journal
                bmim
                Boletín médico del Hospital Infantil de México
                Bol. Med. Hosp. Infant. Mex.
                Instituto Nacional de Salud, Hospital Infantil de México Federico Gómez (México, DF, Mexico )
                1665-1146
                2020
                : 77
                : suppl 1
                : 35-40
                Affiliations
                [7] Ciudad de México orgnameCentro Médico Nacional La Raza México
                [6] Playa del Carmen Quintana Roo orgnameHospital General de Zona No. 18 México
                [2] Ciudad de México orgnameInstituto Nacional de Cardiología Ignacio Chávez México
                [1] Ciudad de México orgnameHospital Infantil de México Federico Gómez México
                [8] Ciudad de México orgnameInstituto Mexicano del Seguro Social orgdiv1Hospital General Regional 220 Mexico
                [11] Cuernavaca Morelos orgnameHospital del Niño y el Adolescente Morelense México
                [5] Ciudad de México orgnameInstituto Nacional de Pediatría México
                [10] Ciudad Victoria Tamaulipas orgnameHospital Infantil de Tamaulipas México
                [3] Ciudad de México orgnameCentro Médico Nacional Siglo XXI México
                [4] Ciudad de México orgnameSociedad Mexicana de Endocrinología Pediátrica México
                [9] Toluca Estado de México orgnameInstituto Materno Infantil del Estado de México México
                Article
                S1665-11462020000700035 S1665-1146(20)07700000035
                10.24875/bmhim.20000087
                914610ff-4b94-496e-a175-c93b575c7b19

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 24 March 2020
                : 28 March 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 67, Pages: 6
                Product

                SciELO Mexico

                Categories
                Guía de práctica clínica para el diagnóstico y el tratamiento de la pubertad precoz

                Treatment,Precocious puberty,Diagnosis,Systematic review,Pubertad precoz,Tratamiento,Diagnóstico,Revisión sistemática

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