Precocious Puberty Diagnoses Spike, COVID-19 Pandemic, and Body Mass Index

Findings From a 4-year Study

Daniela Fava; Carlotta Pepino; Valentina Tosto; Roberto Gastaldi; Alessia Pepe; Dalila Paoloni; Marina Francesca Strati; Alessia Angelelli; Andrea Calandrino; Caterina Tedesco; Tiziana Camia; Anna Elsa Maria Allegri; Giuseppa Patti; Emilio Casalini; Marta Bassi; Maria Grazia Calevo; Flavia Napoli; Mohamad Maghnie

Disclosures

J Endo Soc. 2023;7(9)

Abstract and Introduction

Abstract

Context: Since the COVID-19 outbreak, the number of girls with suspected precocious puberty has increased.

Objective: To compare the incidence of idiopathic central precocious puberty (ICPP) during COVID-19 with that of the previous 4 years.

Methods: Anthropometric, biochemical, and radiological parameters were collected between January 2016 and June 2021 from 133 girls who met the Rapidly Progressive ICPP criteria (RP-ICPP).

Results: We found a higher incidence of RP-ICPP between March 2020 and June 2021 (group 2) compared with January 2016 through March 2020 (group 1) (53.5% vs 41.1%); 2021 showed the highest annual incidence (P < .05). Group 1 and group 2 differed in age at diagnosis (7.96 ± 0.71 vs 7.61 ± 0.94; P < .05), mean Tanner stage (2.86 ± 0.51 vs 2.64 ± 0; P < .05), and in the time between the appearance of thelarche and diagnosis (0.93 ± 0.75 vs 0.71 ± 0.62 years, P < .05). There was an increase in the number of girls aged <8 years in group 2 and a significantly higher number of girls aged >8 years was found in group 1 (42 in group 1 vs 20 in group 2, P< 0.05). Overall body mass index SD score showed higher values in group 2 (1.01 ± 1.23 vs 0.69 ± 1.15;

Table 1. Demographic and anthropometric data of 133 girls diagnosed with rapidly progressive idiopathic central precocious puberty
	Group 1 n = 72	Group 2 n = 61	P value
Clinical/anamnestic data (mean ± SD)
Age at puberty onset (y)	7.03 ± 0.99	6.89 ± 0.99	.25
Age at GnRHa start (y)	7.96 ± 0.71	7.61 ± 0.94	.005
Delta age GnRHa start-puberty onset	0.93 ± 0.75	0.71 ± 0.62	.03
Height SDS	1.65 ± 1.15	1.37 ± 1.18	.21
BMI SDS	0.69 ± 1.15	1.01 ± 1.23	.18
Target height SDS	−0.20 ± 0.95	−0.26 ± 0.85	.74
Delta H-TH SDS	1.88 ± 0.99	1.67 ± 1.09	.26
Tanner stage	2.86 ± 0.51	2.64 ± 0.61	.02
Age at BA evaluation	7.94 ± 0.82	7.55 ± 0.96	.004
Bone age (BA)	9.75 ± 1.29	9.25 ± 1.48	.06
Delta CA-BA	1.80 ± 0.88	1.70 ± 1.02	.46
Age at V1^a	7.46 ± 0.74	7.33 ± 0.63	.29
BMI SDS at V1^a	0.62 ± 1.04	0.77 ± 1.49	.65
Delta BMI SDS (V2-V1)^a	−0.13 ± 0.51	0.12 ± 0.45	.15
Screen time (hours/day)	NA	1.94 ± 1.81
Familial history for CPP (number of patients)	16	12
Endocrine data (mean ± SD)
Baseline LH (U/L)	1.75 ± 2.24	1.26 ± 1.40	.56
LH peak (U/L)	16.22 ± 12.31	16.80 ± 13.17	.10
Baseline FSH (U/L)	4.36 ± 2.43	3.69 ± 2.00	.15
FSH peak (U/L)	11.99 ± 3.69	11.63 ± 3.82	.52
E2 (pg/mL)	19.49 ± 20.06	20.97 ± 22.54	.82
Metabolic data (mean ± SD)
Glycated hemoglobin (%)	5.02 ± 0.27	5.07 ± 0.27	.60
Baseline insulin (uU/mL)	13.34 ± 8.06	17.35 ± 14.22	.22
Triglycerides(mg/dL)	65.85 ± 36.96	67.43 ± 35.33	.61
Total cholesterol(mg/dL)	146.85 ± 24.36	150.62 ± 18.90	.40
HDL cholesterol (mg/dL)	54.91 ± 12.87	61.56 ± 12.21	.03
LDL cholesterol (mg/dL)	80.09 ± 18.10	84.78 ± 18.54	.15
Ultrasound data (mean ± SD)
Uterus length (mm)	37.09 ± 7.50	39.70 ± 8.62	.06
Uterus anteroposterior diameter (mm)	12.45 ± 3.38	11.59 ± 4.42	.08
Right ovary (cm³)	2.51 ± 1.67	2.20 ± 1.48	.25
Left ovary (cm³)	2.44 ± 1.36	2.47 ± 1.66	.69

Group 1: girls diagnosed between January 2016 and March 2020, before the COVID-19 pandemic; group 2: girls diagnosed between March 2020 and the end of June 2021, during the COVID-19 pandemic.
Abbreviations: BA, bone age; BMI, body mass index; CA, chronological age; CPP, central precocious puberty; E2, 17-beta estradiol; GnRHa, GnRH analog; HDL, high-density lipoprotein; H-TH, height-target height; LDL, low-density lipoprotein; NA, not available; SDS, SD score; V1, visit 1; V2, visit 2.
^aGirls diagnosed with slowly progressive idiopathic central precocious puberty at V1 (n = 27/72, 37.5% [group 1] vs n = 17/61, 27.9% [group 2]). All statistically significative P-values (<0.05) have been boldfaced.

Table 2. Mean BMI-SDS at GnRHa start according to chronological age and Tanner stage
Age at GNRHa start		BMI SDS (mean ± SD)
	N	Group 1	N	Group 2	P value
<6 y	n = 2	−0.05 ± 0.78	n = 4	−0.21 ± 0.36	NA
6–6.99 y	n = 4	0.77 ± 1.33	n = 7	1.88 ± 0.95	.11
7–7.99 y	n = 24	0.65 ± 1.17	n = 30	1.03 ± 1.22	.22
>8 y	n = 42	0.75 ± 1.15	n = 20	0.93 ± 1.27	.68
Tanner stage	BMI SDS (mean ± SD)
	N	Group 1	N	Group 2	P value
2	n = 15	0.44 ± 1.04	n = 26	0.85 ± 1.23	.38
3	n = 52	0.81 ± 1.16	n = 31	1.01 ± 1.19	.41
4	n = 5	0.25 ± 1.26	n = 4	2.07 ± 1.33	.06

Table 3. Demographic and anthropometric data of 106 European girls diagnosed with rapidly progressive idiopathic central precocious puberty
	Group 1 n = 60	Group 2 n = 46	P value
Clinical data (mean ± SD)
Age at puberty onset (y)	7.04 ± 1.06	6.93 ± 1.03	.38
Age at GnRHa start (y)	7.97 ± 0.74	7.60 ± 1.00	.01
Delta age GnRHa-puberty onset	0.93 ± 0.79	0.67 ± 0.50	.06
Height SDS	1.34 ± 0.08	1.31 ± 0.10	.27
Tanner stage	2.85 ± 0.48	2.63 ± 0.61	.03
Age at BA evaluation	7.95 ± 0.85	7.56 ± 1.04	.02
BMI SDS	0.61 ± 1.17	0.92 ± 1.20	.28
Target height SDS	−0.18 ± 0.88	−0.17 ± 0.76	.97
Delta H-TH SDS	1.77 ± 0.99	1.63 ± 0.95	.42
BA	9.70 ± 1.31	9.21 ± 1.60	.09
Delta CA-BA	1.76 ± 0.86	1.65 ± 1	.50
Age at V1^a	7.52 ± 0.74	7.27 ± 0.51	.06
BMI SDS at V1^a	0.62 ± 1.03	0.88 ± 1.61	.36
Delta BMI SDS (V2-V1)^a	−0.14 ± 0.55	0.07 ± 0.38	.29
Endocrine data (mean ± SD)
Baseline LH (U/L)	1.76 ± 2.16	1.28 ± 1.43	.53
LH peak (U/L)	16.28 ± 12.35	16.80 ± 11.24	.76
Baseline FSH (U/L)	4.33 ± 2.42	3.82 ± 2.10	.31
FSH peak (U/L)	11.99 ± 3.93	11.73 ± 3.86	.70
E2 (pg/mL)	20.38 ± 20.21	22.11 ± 24.05	.90
Metabolic data (mean ± SD)
Glycated hemoglobin (%)	5.01 ± 0.28	5.04 ± 0.29	.79
Baseline insulin (uU/mL)	12.55 ± 7.87	19.34 ± 15.73	.03
Triglycerides (mg/dL)	65.16 ± 39.03	66.70 ± 36.29	.70
Total cholesterol (mg/dL)	143.10 ± 24.56	149.50 ± 19.69	.16
HDL cholesterol (mg/dL)	53.26 ± 12.22	62.40 ± 12.53	.01
LDL cholesterol (mg/dL)	76.88 ± 17.26	83.16 ± 19.55	.08
Ultrasound data (mean ± SD)
Uterus length (mm)	37.22 ± 7.62	39.40 ± 9.18	.20
Uterus anteroposterior diameter (mm)	12.56 ± 3.52	11.55 ± 4.61	.09
Right ovary (cm³)	2.63 ± 1.76	2.29 ± 1.56	.31
Left ovary (cm³)	2.48 ± 1.32	2.50 ± 1.56	.75

Group 1: Girls diagnosed between January 2016 and March 2020, before Covid-19 pandemic; Group 2: Girls diagnosed between March 2020 and the end of June 2021, during Covid-19 pandemic;
Abbreviations: BA, bone age; BMI, body mass index; E2, 17-beta estradiol; GnRHa, GnRH analog; HDL, high-density lipoprotein; H-TH, height-target height; LDL, low-density lipoprotein; SDS, SD score; V1, visit 1; V2, visit 2.
^aGirls diagnosed as SP-ICPP at V1 (n = 26/60, 43,3% (Group1) vs n = 32/46, 69,6% (Group2)). All statistically significative P-values (<0.05) have been boldfaced.

Table 4. Demographic and anthropometric data of 27 extra-European girls diagnosed with rapidly progressive idiopathic central precocious puberty
	Group 1 n = 12	Group 2 n = 15	P value
Clinical data (mean ± SD)
Age at puberty onset (y)	7.00 ± 0.66	6.78 ± 0.85	.65
Age at GnRHa start (y)	7.95 ± 0.58	7.63 ± 0.73	.35
Delta age GnRHa-puberty onset	0.95 ± 0.60	0.85 ± 0.92	.28
Height SDS	1.79 ± 1.35	1.19 ± 1.70	.43
Tanner stage	2.92 ± 0.67	2.67 ± 0.62	.40
Age at BA evaluation	7.92 ± 0.67	7.51 ± 0.70	.08
BMI SDS	1.11 ± 0.95	1.28 ± 1.31	.40
Target height SDS	−0.35 ± 1.36	−0.56 ± 1.07	1
Delta H-TH SDS	2.51 ± 0.74	1.80 ± 1.52	.55
Bone age (BA)	9.83 ± 1.05	9.55 ± 1.24	.87
Delta CA-BA	1.88 ± 0.83	1.91 ± 1.14	.65
Age at V1^a	7.26 ± 0.76	7.52 ± 0.96	.56
BMI SDS at V1^a	0.63 ± 1.18	0.44 ± 1.21	.73
Delta BMI SDS (V2-V1)^a	−0.07 ± 0.37	0.27 ± 0.67	.56
Endocrine data (mean ± SD)
Baseline LH (U/L)	1.70 ± 2.72	1.20 ± 1.34	1
LH peak (U/L)	15.95 ± 12.77	16.81 ± 18.62	.48
Baseline FSH (U/L)	4.52 ± 2.61	3.31 ± 1.76	.24
FSH peak (U/L)	12.00 ± 2.53	11.32 ± 3.89	.63
E2 (pg/mL)	15.00 ± 19.47	17.21 ± 16.85	.63
Metabolic data (mean ± SD)
Glycated hemoglobin (%)	5.08 ± 0.21	5.13 ± 0.20	.78
Baseline insulin (uU/mL)	16.42 ± 8.50	11.37 ± 5.13	.16
Triglycerides (mg/dL)	69.00 ± 27.69	70.11 ± 33.45	.84
Total cholesterol (mg/dL)	164.71 ± 13.77	154.67 ± 16.04	.30
HDL cholesterol (mg/dL)	61.29 ± 14.29	58.67 ± 11.20	.92
LDL cholesterol (mg/dL)	92.00 ± 17.21	90.56 ± 13.78	.76
Ultrasound data (mean ± SD)
Uterus length (mm)	36.42 ± 7.18	40.64 ± 6.71	.14
Uterus anteroposterior diameter (mm)	11.91 ± 2.66	11.71 ± 3.91	.61
Right ovary (cm³)	1.94 ± 1.09	1.91 ± 1.25	.70
Left ovary (cm³)	2.23 ± 1.58	2.39 ± 2.00	.98

Group 1: girls diagnosed between January 2016 and March 2020, before the COVID-19 pandemic; group 2: girls diagnosed between March 2020 and the end of June 2021, during the COVID-19 pandemic.
Abbreviations: BA, bone age; BMI, body mass index; CA, chronological age; E2, 17-beta estradiol; GnRHa, GnRH analog; HDL, high-density lipoprotein; H-TH, height-target height; LDL, low-density lipoprotein; SDS, SD score; V1, visit 1; V2, visit 2.
^aGirls diagnosed with slowly progressive idiopathic central precocious puberty at V1 (n = 5/12, 41.6% [group 1] vs n = 4/15, 26.6% [group 2]).

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Precocious Puberty Diagnoses Spike, COVID-19 Pandemic, and Body Mass Index

Findings From a 4-year Study

Abstract and Introduction

Abstract

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Authors and Disclosures

Authors and Disclosures

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