Isosexual Precocious Puberty: Single- center experience

INTRODUCTION:

Precociouspuberty (PP) is defined as the onset of secondary sexual characteristics before8 years in girls and 9 years in boys.(1)Observational data from the US show that at age 7, 10%ofwhite girls and 23% of black girls have started puberty.(2)

Precocious puberty is classified as gonadotrophindependent or central precocious puberty (CPP), and gonadotrophin independent orperipheral precocious puberty (PPP).Approximately 90% ofgirls and 25%-60% of boys with CPP have an idiopathic cause (3)(4). Rareassociation with genetic mutations in KISS1, KISS1R, MKRN3 and DLK1 have alsobeen described. Clinicallypatients present with early pubertal changes. LHconcentrations < 0.3 mIU/L are in the prepubertal range, and  >0.3 mIU/L are usually indicative ofpuberty (4)

 GnRHstimulation test should be done in clinically equivocal cases.In the GnRHstimulation test, pubertal individuals have a stimulated peak LH of at least~4-6 mIU/L, whereas prepubertal children will have a minimal increase frombaseline.(5)

   Otherthan arresting puberty, for physical and psychological reasons, preserving adultheight is an important long term goal(4)

Themost common treatment used for CPP is intramuscularleuprolide depot.

Forgonadotrophin-independent precocious puberty, treatment options includearomatase inhibitors, SERM, and androgen synthesis inhibitors likeketoconazole.

Surgeryis the treatment of choice for gonadal tumors.

 There are only a few studies reported from Indiadescribing this condition. Hence, we aim to retrospectively study patients’clinical, biochemical, and treatment profiles with precocious puberty from asingle center in Western India.

AIMS AND OBJECTIVES

·       Tostudy the clinical, biochemical, imaging, management, and outcome of patients withprecocious puberty.

TYPE OF STUDY:Retrospective study

SAMPLESIZE: All patients who had presented to endocrine OPDwillbe included in the study (approximately 100 patients).

INCLUSION CRITERIA:

·       Isosexualprecocious puberty

EXCLUSION CRITERIA:

·       Patientswith heterosexual forms of precocious puberty (e.g congenital adrenalhyperplasia).

·       Patientswith premature thelarche, premature puberache.

STUDY SETTINGS:

Thedata of patients with precocious puberty will be retrieved from medical recordsfrom January 2000 till February 2021 at Seth G.S. Medical college and KEMhospital, Parel, Mumbai.

Thiswill encompass clinical features, biochemical investigations, imaging,management, and outcome details.

METHODOLOGY:

Thisis a retrospective study conducted at a tertiary health care center. Data willbe collected (both baseline and follow up) from medical records of patients withprecociouspuberty. The clinical features (age of presentation, age of diagnosis, gender,family history, symptoms, examination findings), biochemical characteristics (FSH,LH, testosterone, estradiol, 17 OHP, basal cortisol, TFT, beta HCG, GnRHstimulation test), radiological investigations (Xray, USG pelvis, MRI brain etc.)will be recorded.