ESPE Abstracts

Background: The age limit for precocious puberty (PP) in girls is a topic that continues to be debated, and there is a new trend that supports the idea that the beginning of breast development in girls between ages 6 and 8 should not be accepted as true PP and it is necessary to label this clinical condition as accelerated puberty or early normal puberty.

Objective and hypotheses: The aim of the current study is to determine the diagnostic criteria for girls between the ages of 6 and 8, in which puberty has begun as a result of secular trend to early puberty, to decide for which patients treatment initiation is appropriate and rational.

Method: The patients who were diagnosed with idiopathic central PP (CPP) were investigated in four groups as: patients who were treated before age 6, patients who were treated between ages 6 and 7, patients who were treated between ages 7 and 8, and the patients who were treated after age 8. Their final heights were evaluated. A fifth group was formed from patients who were diagnosed after age 7; however, they were not given treatment and were monitored for puberty progress, and the final heights of the group in which treatment was initiated and in which treatment was not initiated were compared.

Results: All of the patients who underwent treatment reached a final height that was close to the target height, and while the final heights were taller than the predicted adult height (PAH) before treatment, the heights were shorter than the PAH at the end of treatment. While the height gain was 11.5±1.6 cm in cases in which treatment began before age 7, it was 6.2±1.8 cm in the group in which treatment began after age 7. The cases who were diagnosed and treated after age 7 and the cases in the same age group who were followed-up without treatment all reached a final height close to the target height and the final heights of both groups were similarly taller than the PAH at the time of diagnosis. The height gain of both groups were also similar. (6.2±1.8 cm vs 5.7±2.0 cm).

Conclusion: Of the cases who were diagnosed with CPP according to the classical definition, the number of cases diagnosed after age 7 was high and the height gain and final heights with or without treatment were similar in this age group. Thus, this suggested that, in fact, the puberty of these cases could be normal and although the age of onset of puberty was earlier due to the secular trend, we might have unnecessarily investigated and treated these cases as we still used the classic age limit of 8 for the definition of PP.