성조숙증 아동의 임상 및 내분비 검사의 특징

김호성,김태형,고희정,김승,이선우,채현욱,김유석,박미정,정소정,유은경,김덕희 대한소아내분비학회 2007 Annals of Pediatirc Endocrinology & Metabolism Vol.12 No.2

Purpose : Precocious puberty is defined as the onset of secondary sexual characteristics before 8 year of age in girls and 9 year in boys. The purpose of this study is to analyze the spectrum of diagnoses made in a consecutive group of children referred for signs of precocious puberty and evaluate the clinical and endocrinologic characteristics of patients with precocious puberty. Methods : The charts of all 948 children referred for evaluation of signs of precocious puberty between January 2003 and June 2007 in several referral centers were reviewed. Clinical features including age of onset, presenting symptoms, yearly growth rate, bone age advancement, weight, height, and body mass index were analysed and endocrine investigations included basal and gonadotropin releasing hormone (GnRH)-stimulated levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH) as well as sex hormones. Results : Of the 948 children referred for signs of precocious puberty, 915 (96.5%) were female and 33 (3.5%) were male. The final diagnoses made were early puberty (39%), premature thelarche (31%), true precocious puberty (27%) and precocious pseudopuberty (1%). The increases in yearly growth rate and bone age advancement were significant in true precious puberty group (P<0.05). The height and weight standard deviation score were significantly increased in true precious puberty and premature thelarche group compared to the average level according to gender and age (P<0.05). Endocrinologic studies showed that the level of basal LH, basal estradiol and GnRH-stimulated peak LH, peak FSH, peak LH/basal LH, peak FSH/basal FSH, peak LH/peak FSH ratio was all significantly higher in true precicous puberty group and early puberty group when compared to premature thelarche group (P<0.05). Neurogenic true precocious puberty among true precocious puberty was more common in boys (3 out of 7, 42.8%) than in girls (27 out of 253, 10.7%). Endocrinologic studies did not show any difference between idiopathic precocious puberty and neurogenic precocious puberty. Conclusion : The result of this study showed the proportion of true precocious puberty among the children referred for early pubertal signs was rather high. Collectively assessing all available data including detailed history, growth records, physical findings, laboratory studies and radiological imaging is important in the evaluation of a child with concerns of early pubertal maturation. Foregoing extensive studies regarding incidence and causes of true precocious puberty should be needed. 목 적 : 성조숙증은 여아에서 8세 미만, 남아에서 9세 미만에 2차 성징이 나타나는 경우로 정의하며, 진성 및 가성 성조숙증으로 구분한다. 성조숙증의 발생빈도는 최근 급격히 증가하고 있어 사회적 문제로 대두되고 있다. 본 연구에서는 성조숙증 증상을 주소로 내원한 환아 들을 대상으로 진단별 분포, 진단명에 따른 임상적 특징을 살펴보고자 하였다. 방 법 : 2003년 1월부터 2007년 6월까지 연세의료원, 상계백병원, 건국의대병원, 분당 차병원에 성조숙증 증상을 주소로 내원한 환아를 진성 성조숙증, 가성 성조숙증, 유방 조기발육증, 조기 사춘기로 분류하였고, 진성 성조숙증은 특발성 성조숙증과 중추신경성 성조숙증으로 분류하였다. 진단 당시의 증상, 가족력, 과거력, 성별, 신장, 체중, 역연령, 골연령, 체질량지수 등을 조사하였다. 기저 및 성선자극호르몬방출호르몬(GnRH) 자극 후 성호르몬, 황체화호르몬(LH), 난포자극호르몬(FSH) 농도를 측정하였다. 원인질환을 확인하기위해 진성 성조숙증으로 진단된 경우에는 터키안 자기공명영상 검사, 가성 성조숙증으로 진단된 경우에는 복부 및 골반 초음파 검사를 시행하였다. 임상적 특징 및 내분비 검사 소견은 각 진단명별로 비교분석하였다. 결 과 : 대상자는 총 948명이었고, 여자는 915명(96.5%), 남자는 33명(3.5%)이었다. 진단별 분포는 조기 사춘기(39 %), 유방 조기발육증(31%), 진성 성조숙증(27%), 가성 성조숙증(1%)의 순서를 보였다. 연성장속도와 골연령의 증가는 진성 성조숙증에서 가장 뚜렷하였다(P<0.05). 진성 성조숙증과 유방 조기발육증군에서 신장 표준편차점수, 체중 표준편차점수가 성별, 나이별 평균보다 유의한 수준으로 증가 되어 있었으며(P<0.05), 모든 군에서 체질량지수는 60 백분위수 이상이었다. 내분비 검사 상 진성 성조숙증과 조기 사춘기의 LH 및 estradiol 기저치와 GnRH 자극 후 LH 최고치, LH 최고치/LH 기저치의 비는 각각 유방 조기발육증보다 높았다(P<0.05). 진성 성조숙증에서 중추신경성 조숙증이 차지하는 비율은 남자에서 42.8%, 여자에서 10.7%로 남자에서 월등히 높았다. 특발성 성조숙증과 중추신경성 성조숙증간에 성호르몬 및 LH, FSH 기저치와 GnRH 자극 후 최고치는 차이가 없었다. 결 론 : 성조숙증 증상을 주소로 내원한 환아 중 진성 성조숙증이 차지하는 비율이 높으므로 보다 자세한 진찰과 검사가 필요하며, 추후 진성 성조숙증의 발생 빈도와 원인에 대한 보다 광범위한 연구가 필요하리라 사료된다.

성조숙증의 원인:호남지역 다기관 연구

나정민,이양진,김민선,이대열,여채영,김찬종,김종덕,김은영 대한소아내분비학회 2009 Annals of Pediatirc Endocrinology & Metabolism Vol.14 No.1

Purpose:We analysed the spectrum of diagnoses made in a consecutive group of children referred for signs of precocious puberty and evaluated the clinical and endocrinologic characteristics. Methods:Retrospective analysis of 375 children (365 girls and 10 boys) referred for evaluation of signs of precocious puberty between January 2003 and May 2007 was done. Results:The conditions causing precocious puberty were early puberty (36.3%), true precocious puberty (30.4%), premature thelarche (29.1%), pseudo-precocious puberty (3.7%), and premature pubarche (0.5%). Among girls, there were differences in the age of onset of puberty (premature thelarche, 5.4±2.6 years vs. true precocious puberty, 6.9±1.1 years vs. early puberty, 8.6±0.5 years). True precocious puberty girls showed higher height SDS (standard deviation score), weight SDS, BMI (body mass index) percentile, basal FSH (follicle stimulating hormone), LH (luteinizing hormone) and estradiol, more accelerated growth velocity and bone age than those with premature thelarche. True precocious puberty patients showed higher height SDS, weight SDS, and more bone age advancement when compared to those with early puberty. Later onset (>2 years) premature thelarche appeared in 89 girls (81.7% of premature thelarche) at 6.4±1.6 years, and among 42 patients followed-up, 8 girls developed true precocious puberty later. Conclusion:Common conditions causing precocious puberty are early puberty, true precocious puberty, and premature thelarche. Although premature thelarche may be regarded as a benign condition, true precocious puberty can develop in some patients, so careful follow-up will be needed. 목적:성조숙증은 2차 성징이 평균치의 2 표준편차보다 빨리 나타날 때로 정의하며, 일반적으로 여아에서 8세 미만, 남아에서 9세 미만에 2차 성징이 나타나는 경우를 의미한다. 저자들은 성조숙증 증상을 주소로 내원한 환아들을 대상으로 원인을 분류하고, 원인별 임상, 성장 및 내분비 검사의 특징을 알아보고자 하였다. 방법:2003년 1월부터 2007년 5월까지 광주기독병원, 전북대병원, 전남대병원, 원광대병원에 성조숙증 증상을 주소로 내원한 환아 375명을 대상으로 하였다. 결과:성조숙증은 대부분 여아에서 발생하였다(97.3 %). 성조숙증의 원인은 조기 사춘기(36.3%), 진성 성조숙증(30.4 %), 조기 유방발육증(29.1%), 가성성조숙증(3.7%), 조기 음모발생증(0.5%) 순이었다. 진성 성조숙증은 대부분 특발성이었고, 뇌 병변은 전체의 5.3%에 불과했다. 조기 유방발육증, 진성 성조숙증, 조기 사춘기 여아 세 군을 비교했을 때, 사춘기 증상이 발현된 당시 나이는 조기 유방발육증 5.4±2.6세, 진성 성조숙증 6.9±1.1세, 조기 사춘기 8.6±0.5세로 차이가 있었다(P<0.05). 3) 진성 성조숙증 여아들은 조기 유방발육증 여아들보다 키 표준편차점수, 체중 표준편차점수, 체질량지수 백분위수, 연성장속도, 골연령과 역연령의 차이, FSH, LH, estradiol 기저치 등이 더 증가되었다(P<0.05). 진성 성조숙증 여아들은 조기 사춘기 여아들보다 키 및 체중 표준편차점수, 골연령 진행은 더 증가되었지만(P<0.05), 체질량지수 백분위수, 성장속도, 성호르몬치는 차이를 보이지 않았다. 조기 유방발육증을, 2세 이전에 유방발달을 보인 조기 발현군과 2세 이후에 보인 후기 발현군으로 구분하였다. 후기군이 더 많았고(81.7%), 추적되었던 후기군 중 19%에서 진성 성조숙증으로 진행하였다. 결론:성조숙증의 흔한 원인은 조기 사춘기, 진성 성조숙증, 조기 유방발육증이었다. 조기 유방발육증의 경우, 시간이 지나면 소실되는 좋은 예후를 보이나, 일부에서 진성 성조숙증으로 진행하는 경우가 있으므로 추적 관찰을 요한다.

중추성 성조숙증 및 조기 사춘기 여아에서 성선자극호르몬 방출호르몬작용제의 용량에 따른 사춘기 억제 효과 비교

심계식,배종우,양유정 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.6

Purpose:There has been considerable disagreement regarding the most appropriate dosage of gonadotropin-releasing hormone agonist in cases of central precocious puberty. The aim of this study was to determine the appropriate dosage for suppression of the puberty in girls with central precocious or early puberty. Methods:Twenty-two girls with early puberty were randomly subjected to 3 types of dosages of leuprolide acetate for at least 6 months. The number of cases in groups 1, 2, and 3 were 7, 7, and 8, and dosages were 70, 90, and 110 µg/ kg/-month, respectively. Height, weight, bone age, Tanner stage of breast development, and serum levels of LH, FSH, estradiol, and progesterone were measured before treatment and after 6 months of treatment. The number of cases of puberty suppression was compared using a modified puberty suppression score with a nonparametric chi-square test. Results:There were no significant differences of chronologic and bone ages among the groups. There was a significant decrease in height SDS gain after 6 months in group 3 (P<0.05) compared with groups 1 and 2. Serum levels of LH, FSH, estradiol and progesterone were all significantly decreased after treatment in all 3 groups (P<0.05). The number of cases of puberty suppression in each group were 4 (57%), 5 (71%), and 8 (100%). There was a significantly increased proportion of suppression of puberty in group 3 (P<0.05). Conclusion:It was necessary to use a higher dose of gonadotropin-releasing hormone agonist to suppress early puberty in girls; however further longitudinal study will be needed for their prognosis of final adult height. (Korean J Pediatr 2008;51:635-639) Purpose:There has been considerable disagreement regarding the most appropriate dosage of gonadotropin-releasing hormone agonist in cases of central precocious puberty. The aim of this study was to determine the appropriate dosage for suppression of the puberty in girls with central precocious or early puberty. Methods:Twenty-two girls with early puberty were randomly subjected to 3 types of dosages of leuprolide acetate for at least 6 months. The number of cases in groups 1, 2, and 3 were 7, 7, and 8, and dosages were 70, 90, and 110 µg/ kg/-month, respectively. Height, weight, bone age, Tanner stage of breast development, and serum levels of LH, FSH, estradiol, and progesterone were measured before treatment and after 6 months of treatment. The number of cases of puberty suppression was compared using a modified puberty suppression score with a nonparametric chi-square test. Results:There were no significant differences of chronologic and bone ages among the groups. There was a significant decrease in height SDS gain after 6 months in group 3 (P<0.05) compared with groups 1 and 2. Serum levels of LH, FSH, estradiol and progesterone were all significantly decreased after treatment in all 3 groups (P<0.05). The number of cases of puberty suppression in each group were 4 (57%), 5 (71%), and 8 (100%). There was a significantly increased proportion of suppression of puberty in group 3 (P<0.05). Conclusion:It was necessary to use a higher dose of gonadotropin-releasing hormone agonist to suppress early puberty in girls; however further longitudinal study will be needed for their prognosis of final adult height. (Korean J Pediatr 2008;51:635-639)

Perception of precocious puberty among school-aged children in South Korea with the experience of treatment for precocious puberty: a Q methodological approach

Sunjung Park,Hye Ri Nam,Eun Ju Choi 한국아동간호학회 2023 Child Health Nursing Research Vol.29 No.3

Purpose: This study aimed to investigate the perceptions of precocious puberty and elucidate the distinct characteristics of each type of perception related to precocious puberty among school-aged children who had undergone treatment for the condition. Methods: This study applied the Q methodology to identify and classify the perceptions of precocious puberty among school-aged children who had undergone treatmentfor the condition. The analysis involved 34 questions from the Q sample and data from 35 individuals in the P sample, using the PC-QUANL Program for analysis. Results: The perceptions of precocious puberty among school-aged children who had undergone precocious puberty treatment were classified into the following four types: "shyness - passive self-management," "resentment - suppression," "anxiety - fear," and "adaptation - acceptance." Conclusion: This study investigated the experiences and perceptions of children who have undergone treatment for precocious puberty. Through the identification of four types of perceptions, we can see that there is a need to develop an intervention program for nursing that is tailored to the specific type of precocious puberty.

정신지체아동의 사춘기

채기화(Chae Ki Hwa) 한독교육학회 2004 교육의 이론과 실천 Vol.9 No.2

정신지체아동의 사춘기는 많은 경우 부모나 교사 등 주위사람들로부터 그 자체가 부정되거나 제대로 이해 받지 못하고 있다. 따라서 정신지체아동이 사춘기에 보이는 일련의 변화는 장애에 고착되어 해석되며 통제할 수 없고 병리적인 색채를 띄는 것으로 인식되는 경향이 있다. 이에 본 연구에서는 정신지체아동이 사춘기를 어떻게 경험하는지를 사회심리와 정신분석의 이론에 의거하여 새롭게 조망해 보았다. 연구결과를 보면 정신지체아동의 경우 사춘기에 성적 발달과 심리, 사회적 발달의 불일치가 첨예화되어 나타난다. 이들은 사춘기에 성적 연령과 지적 연령의 차이에서 오는 어려움, 장애와 관련된 정체성에 관한 물음, 신체의식, 독립에 대한 욕구 등과 관련된 문제들과 대면하게 된다. 정신지체아동의 사춘기 과정의 어려움을 완화시키고 성인으로의 과정을 돕기 위해서는 무엇보다도 이들의 심리사회적 발달을 적극적으로 지원하여야 한다. Puberty is the time of life when children go through a lot of sexual(physical), psychological, and social changes. Especially children are developing their characters through the contact with social environment in their puberty. Due to the challenging power of this age, not only the children who are reaching puberty but also their parents and teachers have a conflicts and problems. But they have to make new efforts for the adaptation to the puberty. In the case of mentally retarded children, however, they are forced to be given up the puberty itself, or they are unlikely to be understood properly by the others who are nearby them. It makes them more difficult in spending their puberty. In addition a series of changes emerging in their puberty are interpreted with their disability. Therefore some people think they are uncontrollable or pathological. In this study discuss the problems that children with mental retardation have faced and the appropriate support to them. As a result of this study, the mentally retarded children in puberty have been faced with a large disagreement between sexual and psycho-social development. It shows us that they also have confronted the difficulties from the difference between sexual and intellectual age, the questions to their identities, the body-image, and the matters like need of independent living. First of all, we need to support psycho-social development to relieve their difficulties in the process of reaching puberty and to help them in that of becoming adults.

The difference in serum alkaline phosphatase levels between girls with precocious puberty and those with normal puberty

좌혜정,양수인,임한혁 대한소아내분비학회 2013 Annals of Pediatirc Endocrinology & Metabolism Vol.18 No.4

Purpose: Serum alkaline phosphatase (ALP) level is the most valid marker of bone formation. Precocious puberty (PP) in girls is characterized by early growth acceleration. The aim of this study was to determine whether serum ALP levels differ between girls with PP and those with normal puberty, and whether ALP level varies with age or Tanner stage. Methods: This retrospective study included girls with PP (n=61) and normal puberty (n=71) who visited the outpatient clinic at Department of Pediatrics, Chungnam National University Hospital from March 2010 to August 2011. We obtained age, height,parental height, weight, bone age, Tanner stage, and concentrations of luteinizing hormone, follicular-stimulating hormone, estradiol, ALP, and insulin-like growth factor-1(IGF-1) from the participants’ medical records. Results: Age and predicted adult height were significantly lower in girls with PP than in those with normal puberty. The height standard deviation score (SDS), weight SDS,body mass index, midparental height, bone age, and IGF-1 level were higher in girls with PP than in those with normal puberty. ALP level was significantly higher in 5- to 8-year-old girls with PP than in age-matched girls with normal puberty. The mean ALP levels were higher in girls with PP than bone age-matched girls with normal puberty (P =0.0003)Conclusion: Serum ALP level showed the significance differences between girls with PP and those with normal puberty. The reasons for and the mechanisms underlying this elevation in serum ALP level in girls with PP should be investigated further.

Diagnosis and constitutional and laboratory features of Korean girls referred for precocious puberty

Kim, Doosoo,Cho, Sung-Yoon,Maeng, Se-Hyun,Yi, Eun Sang,Jung, Yu Jin,Park, Sung Won,Sohn, Young Bae,Jin, Dong-Kyu The Korean Pediatric Society 2012 Clinical and Experimental Pediatrics (CEP) Vol.55 No.12

Purpose: Precocious puberty is defined as breast development before the age of 8 years in girls. The present study aimed to reveal the diagnosis of Korean girls referred for precocious puberty and to compare the constitutional and endocrinological features among diagnosis groups. Methods: The present study used a retrospective chart review of 988 Korean girls who had visited a pediatric endocrinology clinic from 2006 to 2010 for the evaluation of precocious puberty. Study groups comprised fast puberty, true precocious puberty (PP), pseudo PP, premature thelarche, and control. We determined the height standard deviation score (HSDS), weight standard deviation score (WSDS), and body mass index standard deviation score (BMISDS) of each group using the published 2007 Korean growth charts. Hormone tests were performed at our outpatient clinic. Results: The PP groups comprised fast puberty (67%), premature thelarche (17%), true PP (15%), and pseudo PP (1%). Advanced bone age and levels of estradiol, basal luteinizing hormone (LH), and peak LH after gonadotropin-releasing hormone stimulation testing were significantly high in the fast puberty and true PP groups compared with the control group. HSDS, WSDS, and BMISDS were significantly higher in the true PP group than in the control group (P<0.05). Conclusion: The frequent causes of PP were found to be fast puberty, true PP, and premature thelarche. Furthermore, BMISDS were significantly elevated in the true PP group. Therefore, we emphasize the need for regular follow-up of girls who are heavier or taller than others in the same age group.

Diagnosis and constitutional and laboratory features of Korean girls referred for precocious puberty

Doosoo Kim,Sung-Yoon Cho,Se-Hyun Maeng,Eun Sang Yi,Yu Jin Jung,박성원,손영배,진동규 대한소아청소년과학회 2012 Clinical and Experimental Pediatrics (CEP) Vol.55 No.12

Purpose: Precocious puberty is defined as breast development before the age of 8 years in girls. The present study aimed to reveal the diagnosis of Korean girls referred for precocious puberty and to compare the constitutional and endocrinological features among diagnosis groups. Methods: The present study used a retrospective chart review of 988Korean girls who had visited a pediatric endocrinology clinic from 2006 to 2010 for the evaluation of precocious puberty. Study groups comprised fast puberty, true precocious puberty (PP), pseudo PP,premature thelarche, and control. We determined the height standard deviation score (HSDS), weight standard deviation score (WSDS), and body mass index standard deviation score (BMISDS) of each group using the published 2007 Korean growth charts. Hormone tests were performed at our outpatient clinic. Results: The PP groups comprised fast puberty (67%), premature thelarche (17%), true PP (15%), and pseudo PP (1%). Advanced bone age and levels of estradiol, basal luteinizing hormone (LH), and peak LH after gonadotropin-releasing hormone stimulation testing were significantly high in the fast puberty and true PP groups compared with the control group. HSDS, WSDS, and BMISDS were significantly higher in the true PP group than in the control group (P<0.05). Conclusion: The frequent causes of PP were found to be fast puberty,true PP, and premature thelarche. Furthermore, BMISDS were significantly elevated in the true PP group. Therefore, we emphasize the need for regular follow-up of girls who are heavier or taller than others in the same age group.

Psychosocial Aspects in Girls with Idiopathic Precocious Puberty

김은영,Moon In Lee 대한신경정신의학회 2012 PSYCHIATRY INVESTIGATION Vol.9 No.1

Objective Precocious puberty leads to discrepancies between physical and chronological age. The aim of the present study was to evaluate behavioral patterns and social competences in 34 girls with idiopathic precocious puberty. MethodsaaHeight, body weight, and BMI were determined, and pubertal development was assessed. The Korean-child behavior checklist (K-CBCL) was completed by parents. Resultsaa1) Body weight and BMI were significantly higher in precocious puberty group than in the control group. 2) T scores of total social competence and school scales of K-CBCL were significantly higher in the precocious puberty group than in the control group. 3) T scores of externalizing problems and total behavior problems of K-CBCL were also significantly higher in the precocious puberty group. 4) T scores of thought problems and attention problems of K-CBCL were significantly higher in the precocious puberty group than the control group. ConclusionaaAlthough girls with precocious puberty had more behavioral problems, no significant differences were observed between the two study groups in terms of clinically-important T scores. However, the concerns of parents and patients regarding behavioral and emotional changes might be most important when evaluating psychosocial problems. Early recognition, sufficient understanding, communication with patients and parents regarding physical developmental difference from children in the same age, can improve the selfimage of those with precocious puberty.

한약을 이용한 성조숙증에 대한 비임상 연구 보고 고찰

손효은,김영식,김용빈,나선태,김홍준 대한한의학방제학회 2023 大韓韓醫學方劑學會誌 Vol.31 No.4

Objectives : This study aimed to provide basic data for research by investigating non-clinical experimental studies on herbal medicines and its compounds for precocious puberty. Methods : A search was conducted for all literature until October 2023 using combinations of keywords such as precocious puberty, puberty, and chinese medicine in three databases (Pubmed, OASIS, and ScienceON). Results : 1.In animal experiments, studies were mainly conducted using a model that induced precocious puberty by subcutaneously administering danazol to SD rats on the 5th day after birth, and in cell experiments, precocious puberty was induced by treating GT1-7 cells with kisspeptin 10 or estradiol. 2.Anemarrhenae Rhizoma, Phellodendri Cortex, and Prunellae Spica were mainly used as herbal medicine to evaluate their efficacy on precocious puberty in non-clinical experiments. 3.Macroscopic observation, hematological analysis, histological analysis, and genetic analysis were performed as methods to analyze the experimental results. Conclusions : In this study, the effects of herbal medicine on precocious puberty and non-clinical research methods were confirmed. Based on the results of this study, it is expected that non-clinical effectiveness and mechanism research on materials that are clinically effective in Traditional Korean Medicine will be revitalized.