Aggiornamento monografico
La pubertà femminile: come e quando esordisce, con che ritmo procede, quando intervenire
FEMALE PUBERTY: ONSET, DEVELOPMENT AND NEED FOR DIAGNOSTIC WORKUP
SALVATORE DI MAIO
Struttura Complessa di Auxologia ed Endocrinologia, A.O.R.N. Santobono-Pausilipon, Napoli
Gennaio 2002 - pagg. 20 -26
Abstract
Over the last century there has been a trend to earlier onset of female puberty and a great
variability of the age of onset has been observed. A tendency towards a slower pubertal development,
particularly in cases at earlier onset, has also been observed, and it has been
shown that the final growth deficit consequent to early onset puberty may be ultimately
compensated. As a consequence, the age limits for defining when puberty is precocious
and for starting a diagnostic workup have been reexamined. Precocious puberty is now defined
as initial appearance of secondary sexual characters before 7 years of age. Between
7 and 8 years a diagnostic workup is recommended when the speed of pubertal development
appears abnornal. Treatment with LHRH analogues is in principle indicated only in cases with
idiopathic central precocius puberty with onset before 6 years of age.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Kaplowitz PB, Oberfield SE, and the Drug
and Therapeutics and Executive Committees
of the Lawson Wilkins Pediatric Endocrine
Society. Reexamination of the age limit
for defining when puberty is precocious in
girls in the United States: implications for
evaluation and treatment. Pediatrics
1999;104:936-41.
2. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in girls. Arch Dis Child 1969;44:291-303.
3. Largo RH, Prader A. Pubertal development in Swiss girls. Helv Paediatr Acta 1983;38: 229-43.
4. Herman-Giddens ME, Slora EJ, Wasserman RC, et al. Secondary sexual characteristics and menses in young girls in office practice: a study from the Pediatric research in office settings network. Pediatrics 1997; 99:505-12.
5. Rosenfield R, Bachrach LK, Chernausek SD, et al. Current age of onset of puberty (letter). Pediatrics 2000;106:622-3.
6. Cisternino M, Arrigo T, Pasquino AM, et al. Etiology and age incidence of precocious puberty in girls: a multicentric study. J Pediatr Endocrinol Metab 2000;13:695-701.
7. Tanner JM. La Pubertà. In: Auxologia dal feto all’uomo: la crescita fisica dal concepimento alla maturità. Torino: UTET, 1981:53- 67.
8. Boas F. Citato in: Tanner JM. L’età maturativa e i problemi degli anticipi e dei ritardi di maturazione. In: Auxologia dal feto all’uomo: la crescita fisica dal concepimento alla maturità. Torino: UTET, 1981:68-75.
9. Bourguignon JP. Linear growth as a function of age at onset of puberty and sex steroid dosage: therapeutic implications. Endocrine Rewiew 1988;9:467-88.
10. Di Maio S. Pubertà e maturazione scheletrica. In: De Sanctis V, Bertelloni S. Andrologia endocrinologica dell’età evolutiva. Roma: Mediprint, 2000:33-42.
11. Nicoletti I. Disordini dello sviluppo sessuale e puberale. In: Aicardi G, Morabito F, Nicoletti I (eds). Elementi di Auxologia. Ed. Centro Studi Auxologici, 1998:49-61.
12. Stanhope R, Brook CGD. Disorders of puberty. In: Brook CGD (ed). Clinical paediatric endocrinology. Oxford: Blackwell, 1989: 169-88.
13. Bouvattier C, Coste J, Rodrigue D, et al. Lack of effect of GnRH agonists on final height in girls with advanced puberty: a randomized long-term pilot study. J Clin Endocrinol Metab 1999;84:3575-8.
14. Nicholson AB, Hanley C. Indices of physiological maturity: derivation and interrelationships. Child Dev 1953;24:3-38.
15. Grumbach MM, Styne DM. Puberty: ontogeny, neuroendocrinology, physiology, and disorders. In: Wilson J, Foster DW, Kronenberg HM, Larsen PR (eds). Williams Textbook of Endocrinology, 9th Edition. Philadelphia: WB Saunders Company, 1998:1509-25.
16. Sigurjonsdottir TJ, Hayles AB. Precocious puberty: a report of 96 cases. Amer J Dis Child 1968;115:309-21.
17. Bar A, Linder B, Sobel EH, Saenger P, DiMartino-Nardi J. Bayley-Pinneau method of height prediction in girls with central precocious puberty: Correlation with adult height. J Pediatr 1995;126:955-8.
18. Partsch CJ, Heger S, Sippel WG and the German Decapeptyl Study Group. Treatment of central precocious puberty: lessons from a 15 years prospective trial. J Pediatr Endocrinol Metab 2000;13:747-58.
19. Palmert MR, Malin HV, Boepple PA. Unsustained or slowly progressive puberty in young girls: initial presentation and longterm follow-up of 20 untreated patients. J Clin Endocrinol Metab 1999;84:415-23.
20. Roche AF. The final phase of growth. Growth Genet Horm 1989;5:4-6.
21. Shangold MM, Kelly M, Berkeley AS, Freedman KS, Groshen S. Relationship between menarcheal age and adult height. South Medical J 1989;82:443-5.
22. Brauner R, Adan R, Malandry F, Zantleifer D. Adult height in girls with idiopathic true precocious puberty. J Clin Endocrinol Metab 1994;79:415-20.
23. Ghirri P, Bottone U, Gasperi M, et al. Final height in girls with slowly progressive untreated central precocious puberty. Gynecol Endocrinol 1997;11:301-5.
24. Bertelloni S, Baroncelli GI, Sorrentino MC, Perri G, Saggese G. Effect of central precocious puberty and Gonadotropin- releasing hormone analogue treatment on peak bone mass and final height in females. Eur J Pediatr 1998;157:363-7.
25. Kauli R, Gelatzer A, Kornreich L, Lazar L, Pertzelan A, Laron Z. Final height of girls with central precocious puberty, untreated versus treated with cyproterone acetate or GnRH analogue. Horm Res 1997;47:54-61.
26. Cassio A, Cacciari E, Balsamo A, Bal M, Tassinari D. Randomised trial of LHRH analogue treatment on final height in girls with onset of puberty aged 7.5-8.5 years. Arch Dis Child 1999;81:329-32.
27. Marti-Henneberg C, Vizmanos B. The duration of puberty in girls is related to the timing of its onset. J Pediatr 1997;131:618-21.
28. Pescovitz OH, Hench KD, Barnes KM, Loriaux DL, Cutler GB Jr. Premature thelarche and central precocious puberty: the relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone. J Clin Endocrinol Metab 1988;67:474-9.
29. Kreiter M, Burstein S, Rosenfield RL. Moll GW Jr, Cara JF, Yousefzadeh DK. Cuttler L, Levitsky LL. Preserving adult height potential in girls with idiopathic precocious puberty. J Pediatr 1990;117:364-70.
30. Fontoura M, Brauner R, Prevot C, Rappaport R. Precocious puberty in girls: early diagnosis of a slowly progressing variant. Arch Dis Child 1989;64:1170-6.
31. Kletter GB, Kelch RP. Effects of gonadotropin- releasing hormone analog therapy on adulte stature in precocious puberty. J Clin Endocrinol Metab 1994;79:331-4.
32. Paul D, Conte F, Grumbach MM, Kaplan SL. Long-term effect of gonadotropin-releasing hormone agonist therapy on final and near-final height in 26 children with true precocious puberty treated at a median age of less than 5 years. J Clin Endocrinol Metab 1995;80:546-51.
33. Micillo M, Salerno M, Officioso A, Perna E, Gasparini N, Pisaturo L, Di Maio S. Near final height after GnRH agonist treatment in central precocious puberty. J Pediatr Endocrinol Metab 2000;13:787-90.
34. Schoevaart CE, Drop SLS, Otten BJ, Slijper FME, Degenhart HJ. Growth analysis up to final height and psychosocial adjustment of treated and untreated patients with precocious puberty. Horm Res 1990;34:197-203.
35. Ehrhardt AA, Meyer-Bahlberg HFL, Bell JJ. Idiopathic precocious puberty in girls: psychiatric follow-up in adolescence. J Am Acad Child Psychiatry 1984;23:23-33.
36. Sonis WA, Comite F, Blue J, Pescovitz OH, et al. Behavior problems and social competence in girls with true precocious puberty. J Pediatr 1995;126:955-8.
37. Officioso A, Salerno M, Lettiero T, Micillo M, Pisaturo L, Di Maio S. Adolescent girls with idiopathic central precocious puberty: Typical character traits. J Pediatr Endocrinol Metab 2000;13:835-9.
38. Elders MJ, Scott CR, Frindik JP, Kemp SF. Clinical workup for precocious puberty. Lancet 1997;350:457-8 (commentary).
2. Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in girls. Arch Dis Child 1969;44:291-303.
3. Largo RH, Prader A. Pubertal development in Swiss girls. Helv Paediatr Acta 1983;38: 229-43.
4. Herman-Giddens ME, Slora EJ, Wasserman RC, et al. Secondary sexual characteristics and menses in young girls in office practice: a study from the Pediatric research in office settings network. Pediatrics 1997; 99:505-12.
5. Rosenfield R, Bachrach LK, Chernausek SD, et al. Current age of onset of puberty (letter). Pediatrics 2000;106:622-3.
6. Cisternino M, Arrigo T, Pasquino AM, et al. Etiology and age incidence of precocious puberty in girls: a multicentric study. J Pediatr Endocrinol Metab 2000;13:695-701.
7. Tanner JM. La Pubertà. In: Auxologia dal feto all’uomo: la crescita fisica dal concepimento alla maturità. Torino: UTET, 1981:53- 67.
8. Boas F. Citato in: Tanner JM. L’età maturativa e i problemi degli anticipi e dei ritardi di maturazione. In: Auxologia dal feto all’uomo: la crescita fisica dal concepimento alla maturità. Torino: UTET, 1981:68-75.
9. Bourguignon JP. Linear growth as a function of age at onset of puberty and sex steroid dosage: therapeutic implications. Endocrine Rewiew 1988;9:467-88.
10. Di Maio S. Pubertà e maturazione scheletrica. In: De Sanctis V, Bertelloni S. Andrologia endocrinologica dell’età evolutiva. Roma: Mediprint, 2000:33-42.
11. Nicoletti I. Disordini dello sviluppo sessuale e puberale. In: Aicardi G, Morabito F, Nicoletti I (eds). Elementi di Auxologia. Ed. Centro Studi Auxologici, 1998:49-61.
12. Stanhope R, Brook CGD. Disorders of puberty. In: Brook CGD (ed). Clinical paediatric endocrinology. Oxford: Blackwell, 1989: 169-88.
13. Bouvattier C, Coste J, Rodrigue D, et al. Lack of effect of GnRH agonists on final height in girls with advanced puberty: a randomized long-term pilot study. J Clin Endocrinol Metab 1999;84:3575-8.
14. Nicholson AB, Hanley C. Indices of physiological maturity: derivation and interrelationships. Child Dev 1953;24:3-38.
15. Grumbach MM, Styne DM. Puberty: ontogeny, neuroendocrinology, physiology, and disorders. In: Wilson J, Foster DW, Kronenberg HM, Larsen PR (eds). Williams Textbook of Endocrinology, 9th Edition. Philadelphia: WB Saunders Company, 1998:1509-25.
16. Sigurjonsdottir TJ, Hayles AB. Precocious puberty: a report of 96 cases. Amer J Dis Child 1968;115:309-21.
17. Bar A, Linder B, Sobel EH, Saenger P, DiMartino-Nardi J. Bayley-Pinneau method of height prediction in girls with central precocious puberty: Correlation with adult height. J Pediatr 1995;126:955-8.
18. Partsch CJ, Heger S, Sippel WG and the German Decapeptyl Study Group. Treatment of central precocious puberty: lessons from a 15 years prospective trial. J Pediatr Endocrinol Metab 2000;13:747-58.
19. Palmert MR, Malin HV, Boepple PA. Unsustained or slowly progressive puberty in young girls: initial presentation and longterm follow-up of 20 untreated patients. J Clin Endocrinol Metab 1999;84:415-23.
20. Roche AF. The final phase of growth. Growth Genet Horm 1989;5:4-6.
21. Shangold MM, Kelly M, Berkeley AS, Freedman KS, Groshen S. Relationship between menarcheal age and adult height. South Medical J 1989;82:443-5.
22. Brauner R, Adan R, Malandry F, Zantleifer D. Adult height in girls with idiopathic true precocious puberty. J Clin Endocrinol Metab 1994;79:415-20.
23. Ghirri P, Bottone U, Gasperi M, et al. Final height in girls with slowly progressive untreated central precocious puberty. Gynecol Endocrinol 1997;11:301-5.
24. Bertelloni S, Baroncelli GI, Sorrentino MC, Perri G, Saggese G. Effect of central precocious puberty and Gonadotropin- releasing hormone analogue treatment on peak bone mass and final height in females. Eur J Pediatr 1998;157:363-7.
25. Kauli R, Gelatzer A, Kornreich L, Lazar L, Pertzelan A, Laron Z. Final height of girls with central precocious puberty, untreated versus treated with cyproterone acetate or GnRH analogue. Horm Res 1997;47:54-61.
26. Cassio A, Cacciari E, Balsamo A, Bal M, Tassinari D. Randomised trial of LHRH analogue treatment on final height in girls with onset of puberty aged 7.5-8.5 years. Arch Dis Child 1999;81:329-32.
27. Marti-Henneberg C, Vizmanos B. The duration of puberty in girls is related to the timing of its onset. J Pediatr 1997;131:618-21.
28. Pescovitz OH, Hench KD, Barnes KM, Loriaux DL, Cutler GB Jr. Premature thelarche and central precocious puberty: the relationship between clinical presentation and the gonadotropin response to luteinizing hormone-releasing hormone. J Clin Endocrinol Metab 1988;67:474-9.
29. Kreiter M, Burstein S, Rosenfield RL. Moll GW Jr, Cara JF, Yousefzadeh DK. Cuttler L, Levitsky LL. Preserving adult height potential in girls with idiopathic precocious puberty. J Pediatr 1990;117:364-70.
30. Fontoura M, Brauner R, Prevot C, Rappaport R. Precocious puberty in girls: early diagnosis of a slowly progressing variant. Arch Dis Child 1989;64:1170-6.
31. Kletter GB, Kelch RP. Effects of gonadotropin- releasing hormone analog therapy on adulte stature in precocious puberty. J Clin Endocrinol Metab 1994;79:331-4.
32. Paul D, Conte F, Grumbach MM, Kaplan SL. Long-term effect of gonadotropin-releasing hormone agonist therapy on final and near-final height in 26 children with true precocious puberty treated at a median age of less than 5 years. J Clin Endocrinol Metab 1995;80:546-51.
33. Micillo M, Salerno M, Officioso A, Perna E, Gasparini N, Pisaturo L, Di Maio S. Near final height after GnRH agonist treatment in central precocious puberty. J Pediatr Endocrinol Metab 2000;13:787-90.
34. Schoevaart CE, Drop SLS, Otten BJ, Slijper FME, Degenhart HJ. Growth analysis up to final height and psychosocial adjustment of treated and untreated patients with precocious puberty. Horm Res 1990;34:197-203.
35. Ehrhardt AA, Meyer-Bahlberg HFL, Bell JJ. Idiopathic precocious puberty in girls: psychiatric follow-up in adolescence. J Am Acad Child Psychiatry 1984;23:23-33.
36. Sonis WA, Comite F, Blue J, Pescovitz OH, et al. Behavior problems and social competence in girls with true precocious puberty. J Pediatr 1995;126:955-8.
37. Officioso A, Salerno M, Lettiero T, Micillo M, Pisaturo L, Di Maio S. Adolescent girls with idiopathic central precocious puberty: Typical character traits. J Pediatr Endocrinol Metab 2000;13:835-9.
38. Elders MJ, Scott CR, Frindik JP, Kemp SF. Clinical workup for precocious puberty. Lancet 1997;350:457-8 (commentary).