J Korean Med Assoc.  2009 Dec;52(12):1189-1200. 10.5124/jkma.2009.52.12.1189.

Observed Trends for an Earlier Onset of Puberty: When is the Need for Treatment Indicated?

Affiliations
  • 1Department of Pediatrics, Seoul National University College of Medicine, Korea. chshinpd@snu.ac.kr
  • 2Department of Pediatrics, Boramae Medical Center, Korea.

Abstract

Globally, there is a secular trend toward earlier puberty and an increased final height at adulthood. In Korea, there is a trend toward an earlier menarche in girls but insufficient data to evaluate secular trends in boys. A significant increase in height was observed in Koreans aged 0~20 years during 1965~2005. This trend has diminished, but growth maturation has accelerated in infants and young children. Genetic and environmental factors including nutritional status (e.g., obesity) contribute to these changes. Central precocious puberty results from the accelerated activation of the hypothalamic-pituitary-gonadal axis. Although the cut-off age is controversial, clinical evaluations should be conducted on girls with pubertal onset occurring younger than 8 years, and on boys younger than 9 years at least until further prospective studies define the norms for Korea. Management of precocious puberty depends on the underlying etiology, as accelerated puberty can lead to a reduced final adult height. Depot forms of GnRH agonists (GnRHas) are the standard treatment for some patients with central precocious puberty. These agents can help restore the normal adult height in both girls and boys when it might be compromised by rapidly progressive precocious puberty. However, in girls with slowly progressive precocious puberty or with the onset of puberty at 8~9.9 years of age (early normal puberty), GnRHa treatment might offer no benefit for attaining normal height. There is little evidence on whether psychosocial problems are associated with precocious puberty or are improved by GnRHa treatment.

Keyword

Puberty; Secular trend; Precocity

MeSH Terms

Adult
Aged
Axis, Cervical Vertebra
Child
Female
Gonadotropin-Releasing Hormone
Humans
Infant
Korea
Menarche
Nutritional Status
Puberty
Puberty, Precocious
Gonadotropin-Releasing Hormone

Figure

  • Figure 1 Hormonal changes during puberty. Abbreviations: CNS, central nervous system; LH, luteinizing hormone; LHRH, LH releasing hormone; GH, growth hormone

  • Figure 2 Distribution of timing of puberty in different condition.

  • Figure 3 Secular trend in mean height from 1965 to 2005 in Korean girls (A) and boys (B).

  • Figure 4 Secular differences corrected by investigation interval in mean height between 2005 and 1997 (shaded bar, solid line), and between 1997 and 1984 (open bar, dotted line) in Korean girls (A) and boys (B).

  • Figure 5 (A) Height velocity for American boys. Dash line, 50th centile for boys 2 SD of tempo early; chain line, 50th centile for boys 2 SD of tempo late, respectively (36). (B) Secular trend in the mean peak height velocity for boys based on the Swedish longitudinal studies (2).

  • Figure 6 Adult height of in girls treated with GnRH agonist for progressive central precocious puberty. Abbreviations: TH; target height, iPAH; initial predicted adult height before treatment, FH; final adult height

  • Figure 7 Adult height of in girls with early puberty. Abbreviations: TH, target height; iPAH, initial predicted adult height before treatment; FH, final adult height; Th(+), treated with GnRH agonist; Th(-), without treatment


Cited by  3 articles

Adult height in girls with central precocious puberty without gonadotropin-releasing hormone agonist treatment: a retrospective case-control study
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J Yeungnam Med Sci. 2023;40(Suppl):S81-S86.    doi: 10.12701/jyms.2023.00801.

Depression and self-concept in girls with perception of pubertal onset
Ji Hyeon Yang, Sang Woo Han, Chan Woo Yeom, Yong Jun Park, Wha Su Choi, Ji Young Seo, Young Jin Koo
Ann Pediatr Endocrinol Metab. 2013;18(3):135-140.    doi: 10.6065/apem.2013.18.3.135.

Effects of gonadotropin-releasing hormone agonist treatment on final adult height in boys with idiopathic central precocious puberty
Ah Young Cho, Su Yeong Ko, Jae Hee Lee, Eun Young Kim
Ann Pediatr Endocrinol Metab. 2021;26(4):259-265.    doi: 10.6065/apem.2040268.134.


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