An Approach to the Evaluation and Management of the Obese Child With Early Puberty.

Autor:	Tenedero CB; Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.; Department of Pediatrics, University of Toronto, Toronto, Ontario M5S 1A1, Canada., Oei K; Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.; Department of Pediatrics, University of Toronto, Toronto, Ontario M5S 1A1, Canada., Palmert MR; Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario M5G 1X8, Canada.; Department of Pediatrics, University of Toronto, Toronto, Ontario M5S 1A1, Canada.; Department of Physiology, University of Toronto, Toronto, Ontario M5S 1A1, Canada.
Jazyk:	angličtina
Zdroj:	Journal of the Endocrine Society [J Endocr Soc] 2021 Nov 19; Vol. 6 (1), pp. bvab173. Date of Electronic Publication: 2021 Nov 19 (Print Publication: 2022).
DOI:	10.1210/jendso/bvab173
Abstrakt:	With the declining age at onset of puberty and increasing prevalence of childhood obesity, early breast development in young obese girls has become a more frequent occurrence. Here, we examine available literature to answer a series of questions regarding how obesity impacts the evaluation and management of precocious puberty. We focus on girls as the literature is more robust, but include boys where literature permits. Suggestions include: (1) Age cutoffs for evaluation of precocious puberty should not differ substantially from those used for nonobese children. Obese girls with confirmed thelarche should be evaluated for gonadotropin-dependent, central precocious puberty (CPP) to determine if further investigation or treatment is warranted. (2) Basal luteinizing hormone (LH) levels remain a recommended first-line test. However, if stimulation testing is utilized, there is a theoretical possibility that the lower peak LH responses seen in obesity could lead to a false negative result. (3) Advanced bone age (BA) is common among obese girls even without early puberty; hence its diagnostic utility is limited. (4) Obesity does not eliminate the need for magnetic resonance imaging in girls with true CPP. Age and clinical features should determine who warrants neuroimaging. (5) BA can be used to predict adult height in obese girls with CPP to inform counseling around treatment. (6) Use of gonadotropin-releasing hormone analogues (GnRHa) leads to increased adult height in obese girls. (7) Obesity should not limit GnRHa use as these agents do not worsen weight status in obese girls with CPP. (© The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society.)
Databáze:	MEDLINE
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