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Published on: October 13, 2018
Central precocious puberty in boys: secular trend and clinical features
Heta Huttunen1, Juho Kärkinen1, Tero Varimo1
1New Children's Hospital, Pediatric Research Center, Helsinki University Hospital, Helsinki 00014, Finland.
Insights
The incidence of male central precocious puberty (CPP) is increasing, driven by idiopathic cases. Organic CPP is associated with younger age, shorter stature, and higher testosterone levels, aiding diagnosis.
Area of Science:
- Pediatric Endocrinology
- Reproductive Health
- Clinical Research
Background:
- Growing concern regarding earlier puberty onset in boys.
- Increasing incidence of male central precocious puberty (CPP).
- Need to differentiate organic CPP (OCPP) from idiopathic CPP (ICPP).
Purpose of the Study:
- To investigate the incidence of male CPP.
- To identify clinical and auxological indicators for OCPP.
- To analyze trends in CPP and OCPP incidence.
Main Methods:
- Retrospective registry-based study.
- Analysis of medical records from 43 boys with CPP (1985-2014).
- Inclusion of clinical, auxological, and endocrine data.
Main Results:
- CPP incidence in boys (2010-2014) was 0.34 per 10,000.
- Overall male CPP incidence increased significantly between 1990-2014 (IRR 1.10).
- Increased incidence driven by ICPP; OCPP incidence remained stable.
- OCPP patients were younger, shorter, and had higher basal testosterone than ICPP patients.
- Combination of clinical cues showed high accuracy (AUC 0.84-0.97) in differentiating OCPP from ICPP.
Conclusions:
- Male CPP incidence is 0.34 per 10,000, with 26% having intracranial pathology.
- Rising CPP rates are primarily due to increased ICPP.
- Younger age, shorter stature, and higher testosterone levels are key indicators for OCPP.
- Utilizing multiple clinical cues can aid in diagnostic decision-making for CPP etiology.
Objective:
Recent studies suggest that boys enter puberty at a younger age, and the incidence of male central precocious puberty (CPP) is increasing. In this study, we explore the incidence of male CPP and identify key clinical and auxological indicators for organic CPP (OCPP).
Design:
A retrospective registry-based study.
Methods:
The medical records of 43 boys treated with CPP at the Helsinki University Hospital between 1985 and 2014 were reviewed. Clinical, auxological, and endocrine data of the CPP patients were included in the analyses.
Results:
Based on brain MRI, 26% of patients had OCPP. Between 2010 and 2014, the CPP incidence in boys was 0.34 per 10 000 (95% CI 0.20-0.60). Between 1990 and 2014, the male CPP incidence increased (incidence rate ratio [IRR] 1.10, P = .001). This increase was driven by rising idiopathic CPP (ICPP) incidence (IRR 1.11, 95% CI 1.05-1.19, P < .001), while OCPP incidence remained stable (P = .41). Compared with the patients with ICPP, the patients with OCPP were younger (P = .006), were shorter (P = .003), and had higher basal serum testosterone levels (P = .038). Combining 2 to 4 of these readily available clinical cues resulted in good to excellent (all, area under the curve 0.84-0.97, P < .001) overall performance, differentiating organic etiology from idiopathic.
Conclusions:
The estimated incidence of CPP in boys was 0.34 per 10 000, with 26% of cases associated with intracranial pathology. The increase in CPP incidence was driven by rising ICPP rates. Patients with OCPP were characterized by shorter stature, younger age, and higher basal testosterone levels, providing valuable cues for differentiation in addition to brain MRI. Utilizing multiple cues could guide diagnostic decision-making.
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