ESPE Abstracts

Background: Puberty onset results from the interplay between genetic and environmental factors. During COVID-19 pandemic, children experienced epidemic-related changes, such as stress, sedentary lifestyle, excessive use of electronic devices, all leading to weight gain.

Objective: The aim of our study is to retrospectively evaluate the incidence of premature activation of the hypothalamic-pituitary-gonadal axis, as evidenced by positive GnRH (Gonadotropin-Releasing Hormone) stimulation tests, during and after the Greek lockdown for COVID-19 (4/2020-3/2023;COVID group), comparing with corresponding data from the previous two years (1/2018-3/2020;pre-COVID group).

Method: Children with suspected early puberty, who were referred to the Division of Endocrinology, were identified by electronic medical records. The children were referred due to (i) pubertal changes, at chronological ages < 8, and < 9 years for girls and boys, respectively, (ii) accelerated pubertal progression, and/or (iii) random basal luteinizing hormone (LH) > 0.3IU/L. GnRH analogue (GnRHa) was administered intravenously with subsequent blood samplings for FSH (Follicle-stimulation hormone) and LH at 30’, and 60’. Samples at 0’ were obtained for a full endocrinologic panel. A cut-off value of GnRHa-stimulated LH ≥ 5IU/L and a ratio of stimulated LH/FSH≥0.6 were considered diagnostic for pubertal response.

Results: Between April 2020-March 2023, 359 children (10.25 cases/month) were referred for suspected early puberty, compared to 163 subjects (6.27 cases/month) during January 2018-March 2020 (+63.48%). A significant increase of pubertal response was observed in the COVID group (53.7% vs 44.17%, in the COVID, and pre-COVID group, respectively; P<0.001), with the percentage of girls being significantly higher (176/193 vs 62/72 girls, equivalent to 91% vs 86,1%, in the COVID, and pre-COVID period, respectively; P<0.05) in both groups. The majority of cases was observed after the nationwide lockdown revocation (1-12/2021 with 81 cases, vs 38, 58, and 16 cases during 2020, 2022, and 1-3/2023, respectively). Interestingly, the age at diagnosis was 7.166±1.86 years in the pre-COVID-group, and 7.466±1.32 years during COVID-19 period, probably due to parental reluctancy for prompt consultation. Higher basal, and peak stimulated LH were observed in the COVID group.

Conclusion: The lockdowns during the pandemic, school closures, social distancing, and financial insecurity could have affected pubertal onset and course, due to severe emotional distress, sedentary lifestyle, and weight gain.