Background: Several studies observed a positive secular trend for the occurrence of earlier puberty. Genetic background, weight gain, and environmental factors are assumed as contributors. In March 2020, WHO declared a worldwide pandemic of COVID-19. To reduce transmission, Germany and many other countries imposed regulations of social distancing and lockdowns leading to significant changes in daily life for children followed by an increase in obesity but also in the incidence of psychological disturbances. As reported from Italy, we noticed an unusual high number of girls diagnosed with central precocious puberty (CPP).
Aims of the study: Retrospective single center evaluation of newly diagnosed CPP incidence during the pandemic (group A), comparing data with previous five years (2015-2019; group B). In addition, a German-wide survey of all pediatric-endocrinological centers on the frequency of CPP was conducted.
Patients and methods: Auxological, clinical, endocrinological and radiological data from patients who presented with CPP 2015-2021.
Results: Number of patients with CPP remained stable (n<10/year) for 2015-2019. In 2020 numbers more than doubled (n=23) with a further increase (n=30) in 2021[WJ3]. This was confirmed by the survey: 28/43 (65%) reported an increase, confirmed by those who could quantify their patient number (2019: n=608; 2020: n=845; 2021: n=1140). Differences were observed between the two groups. Although mean BMI-SDS was not different between the two groups at time of diagnosis, it was already in the upper normal range in group B at the age of five years (0.74; SD 0.9) with no significant change thereafter (0.87; SD 0.8) whereas a significant increase was observed in group A (BMI-SDS at 5yrs: 0.002 (SD 1.1); at diagnosis: 0.55; SD 1.1; P=0.04). Patients diagnosed during the pandemic were significantly younger than those diagnosed previously (6.86 yrs SD 1.9 vs 7.6 SD 1.3; P<0.05). Tanner stages at diagnosis in girls out of group B were significantly more advanced than those diagnosed during the pandemic. No significant differences were found for endocrine or sonographic parameters. In both groups mean time of menarche of mothers was comparably early (11.7 yrs SD 1.4 vs 11.9 yrs SD 1.4).
Conclusion: Our data confirms Italian data showing an increased incidence of newly diagnosed CPP during and after lockdown compared to previous years. The known positive secular trend for thelarche might be aggravated by psychosocial and environmental factors e.g. disproportional weight gain. Additionally greater awareness of the family for physical changes of their children could be assumed.
15 Sep 2022 - 17 Sep 2022