Precocious Puberty: When the Cause is not Idiopathic

Precocious Puberty is defined by the onset of pubertal development at an age 2-2,5 standard deviations earlier than the normal population, which means before nine years old in boys and eight years in girls. Central Precocious Puberty (CPP) is diagnosed when the hypothalamic-pituitary axis is activated. Although the majority of CPP causes are idiopathic, secondary causes should be discharged because of pathologic conditions with significant risk of morbidity and even death.

Aims: To evaluate the prevalence of secondary CPP in the Portuguese population in the last five years, to characterize anthropometric and imagological features and identify its clinical predictors.

Methods: Cross-sectional study from a National Digital Database, enrolled from eleven Public and Private Pediatric Endocrine Departments. Cases reported from January 2013 to December 2017. Statistical analysis was performed using SPSS^TM 23.0 version.

Results: A total of 210 cases presented CPP during the last five years. 187 (89%) were female. The median age of diagnosis was 6,5 years old in idiopathic CPP and 4,8 years old in secondary CPP (p=0,002). Only 146 (69.5%) enrolled hypophyses/cranial image and secondary cases of CPP were identified in 38 patients (26%). Tumors were diagnosed in ten cases (26,3% of the secondary CPP) and the most frequent was hamartoma in 60%. From the secondary cases of CPP only 17 were male (12%) and there were no significant differences among gender when considering idiopathic/secondary cases. There was a negative correlation between the age of clinical manifestations (p<0.001) and secondary CPP.

Conclusions: CPP is more frequent in girls, either in idiopathic or secondary cases. The yearly age of clinical manifestations is a better predictor than gender in the diagnosis of secondary CPP.