Phthalate Exposure and Precocious Puberty in Females
Jefferson P. LomenickAntonia M. CalafatMaria S. Melguizo CastroRichard J. MierPeggy StengerMichael B. FosterKupper A. Wintergerst
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Central precocious puberty
Precocious puberty defined by the onset of secondary sexual characteristics before 8 years in girls and 9 years in boys. It is more common in females than males and is usually sporadic. Depending on the primary source of hormonal production, precocious puberty is classified as central and peripheral. Precocious puberty in infants is very rare. While investigating a case of precocious puberty, it is essential to progress systematically, with an identification of isolated or complete precocious puberty followed by bone age estimation, relevant hormonal assays, including GnRH stimulation, as well as neuroimaging when indicated. We present a case of isosexual (central) precocious puberty in a 1 year, 3-month-old girl, who was symptomatic for 1 year of age and was diagnosed to have hypothalamic hamartoma after methodical evaluation and responded to treatment with GnRH agonists.
Central precocious puberty
Hypothalamic disease
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OBJECTIVE: To determine whether phthalate exposure is associated with precocious puberty in girls.STUDY DESIGN: This was a multicenter cross-sectional study in which 28 girls with central precocious puberty (CPP) and 28 age- and race-matched prepubertal females were enrolled. Nine phthalate metabolites and creatinine were measured in spot urine samples from these 56 children.RESULTS: Levels of 8 of the 9 phthalate metabolites were above the limit of detection (LOD) in all 56 subjects. Mono (2-ethylhexyl) phthalate (MEHP) was below the LOD in 25/56 samples (14 subjects with precocious puberty and 11 controls). No significant differences between the children with CPP and the controls in either absolute or creatinine-normalized concentrations of any of the 9 phthalate metabolites were measured.CONCLUSIONS: Although phthalates may be associated with certain other toxicities in humans, our study suggests that their exposure is not associated with precocious puberty in female children.Copyright 2010 Mosby, Inc. All rights reserved. PMID: 19892364
Central precocious puberty
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Central precocious puberty
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Gonadotropin-releasing hormone (GnRH) has been the standard test for diagnosing central precocious puberty. Because GnRH is no longer available, GnRH analogues (GnRHa) are now used. Random LH concentration, measured by the third-generation immunochemiluminometric assay, is a useful screening tool for central precocious puberty. However, GnRHa stimulation test should be considered, when a basal LH measurement is inconclusive. However optimal sampling times for luteinizing hormone (LH) have yet to be established. To determine the appropriate sampling time for LH post leuprolide challenge. A retrospective analysis of multi-sample GnRHa stimulation tests performed in 155 children (aged 1–9 years) referred for precocious puberty to Texas Children's Hospital. After 20 mcg/kg of SQ leuprolide acetate, samples were obtained at 0, 1, 3, and 6 hours. Of 71 children with clinical evidence of central precocious puberty, fifty nine children had a peak LH >5 mIU/mL. 52 (88%) of these responders had positive responses at 1 hour (95% CI is 80–96%), whereas all 59 children (100%) had a peak LH response >5 mIU/mL at 3 hours (95% CI is 94-100%), P = 0.005. A single serum LH sample collected 3 hours post GnRHa challenge is the optimal sample to establish the diagnosis of central precocious puberty.
Central precocious puberty
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Leuprorelin
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Precocious puberty is a condition characterized by the development of secondary sexual characteristics before the median age for sex. It can be central (gonadotropin dependent) also called true precocious puberty or peripheral (gonadotropin independent) also known as pseudo precocious puberty. Two Ghanaian children with central and pseudo precocious puberty are being presented. The central precocious puberty was due to arachnoid cyst in the brain of a 4-year-old boy whilst the pseudo precocious puberty was as a result of granulosa cell tumour of the right ovary. No such cases have, previously, been reported in Ghana.
Central precocious puberty
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Sexual maturity
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A notable secular trend in early puberty onset has been described over the past few decades. Also, the prevalence and incidence of precocious puberty is increasing not only in Korea, but also around the world. The manifestation of secondary sex characteristics before 8 years in girls and 9 years in boys is defined as precious puberty. The causes of precocious puberty can be classified as gonadotropin releasing hormone (GnRH)-dependent, also known as central precocious puberty (CPP), or GnRH-independent. Evaluation of patient with precocity requires detailed examination of the clinical manifestation, GnRH stimulation test, and imaging of the central nervous system if indicated. The standard treatment for CPP is GnRH agonist, which is beneficial for adequate pubertal development and preservation of final adult height. In this paper, we investigate the diagnosis and adequate treatment of CPP.
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Objectives To analyze clinical characteristics of precocious puberty attributed to tumors. Methods Hospital-based analysis was performed for 24 adolescents with precocious puberty associated with tumors. Results Percen- tage of precocious puberty attributed to tumors in boys was 12.93%, while the percentage in girls was 0.50%. Significantly advanced bone age (BA), and obviously higher levels of LH and FSH (before and after the GnRH stimulation test) were found after the transformation from peripheral precocious puberty (PPP) to central precocious puberty (CPP). Conclu- sions The incidence of precocious puberty attributed to tumors was significantly higher in boys than that in girls. Adolescents with PPP associated with tumors will transform to CPP after operation.
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Creatinine concentration is commonly used to verify the authenticity of urine specimens submitted for illicit drug screening. This study evaluated creatinine screening of donor urine specimens as a tool for detecting substituted and/or tampered specimens. The study carried out creatinine assay of animal urine, fruit juices, and urine from creatine-supplemented subjects by a modified version of the Jaffe reaction. All specimens were analyzed for creatinine concentration in a chemistry-immuno analyzer. Results showed that urine specimens from common domestic pets, including cats, dogs, and horses, have creatinine values similar to normal human values. Most fruit juices tested contained no detectable creatinine, and the few that did showed poor "urine" chemical integrity. Creatine supplementation by donors was found not to provide an effective means of elevating creatinine concentration in urine when attempting to flush out water-soluble drugs in the body. Thus, the assay for creatinine proved useful for the detection of some but not all adulterated urine specimens.
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Precocious puberty is a rare condition characterized by the development of secondary sexual characteristics before the median age for the sex. It is either gonadotropin dependent also called as central or gonadotropin independent also known as peripheral type. Hypothalamamic Hamartoma is a common cause of the central or precocious puberty due to organic brain lesion. Here we present a two year male who presented us with precocious puberty due to a hypothalamic Hamartoma.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6353 Kathmandu Univ Med J 2011;9(4):315-7
Central precocious puberty
Hamartoma
Gonadotropin
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Precocious pubertal is frequent and should lead to a rigorous evaluation. It is important to precisely evaluate the timing of pubertal development, and to search for an hypothalamic lesion in cases of central precocious puberty. It is also important to recognize that many cases of precocious puberty will not progress and therefore do not need treatment. When central precocious puberty has been confirmed, GnRH agonists should be considered. Management issues, as well as long term results of these treatments are presented.
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