Clinical standards for growth velocity in height of Belgian boys and girls,aged 2 to 18 years

The present paper presents the first clinical standards for growth velocity in height of Belgian boys and girls, based on purely longitudinal data. Growth charts are provided with centiles of height for age, along with the growth velocity curves of the typical early, average and late maturing child in the population. These new growth velocity standards provide centile lines which allow to judge whether a child's growth velocity over a one-year interval lies within the limits of normal variation for his age, irrespective of his stage of maturation. They also provide information about variability in the individual patterns of growth velocity in the population and can, as such, also be used to evaluate the normality of a child's pattern in growth velocity over a longer period of time. Age at peak velocity occured in 95% of the children within an age range of about 4 years. The average age at peak height velocity at puberty was 14.0 years (S.D.=1.0) in boys and 11.6 years (S.D.=0.9) in girls. Peak height velocity was in the average 9.1 cm/year (S.D.=1.4) in boys and 7.5 cm/year (S.D.=1.1) in girls. The representativity of these new standards with respect to the actual Belgian population was tested by comparison with recent cross-sectional data, collected on a large number of subjects. These new charts will find useful applications in longitudinal health screening surveys, and in clinical follow-up studies, where interest lies in the examination of a child's growth retardation in relation to some disease, or catch-up growth, as a response to subsequent medical treatment.     

Final height in children with idiopathic growth hormone deficiency treated with recombinant human growth hormone: the Belgian experience

BACKGROUND: The growth response to recombinant hGH (rhGH) treatment and final height of 61 Belgian children (32 boys) with idiopathic growth hormone deficiency (GHD) were studied. PATIENTS/METHODS: Two patient groups were compared: Group 1 with spontaneous puberty (n = 49), Group 2 with induced puberty (n = 12). The patients were treated with daily subcutaneous injections of rhGH in a dose of 0.5-0.7 IU/kg/week (0.17-0.23 mg/kg/week) from the mean +/- SD age of 11.9 +/- 3.1 years during 5.1 +/- 2.1 years. RESULTS: rhGH treatment induced a doubling of the height velocity during the first year and resulted in a normalisation of height in 53 (87%) patients. Final height was -0.7 +/- 1.1 SDS, being 170.4 +/- 7.2 cm in boys and 158.0 +/- 6.4 cm in girls. Corrected for mid-parental height, final height was 0.0 +/- 1.1 SDS. Ninety-two percent of the patients attained an adult height within the genetically determined target height range. Although height gain during puberty was smaller in the patients with induced puberty (boys: 17.1 +/- 7.0 cm vs. 27.5 +/- 6.6 cm (p < 0.005); girls: 9.6 +/- 7.4 cm vs. 22.2 +/- 6.1 cm (p < 0.005)), no differences in final height after adjustment for mid-parental height were found between patients with spontaneous or induced puberty. CONCLUSIONS: We conclude that patients with idiopathic GHD treated with rhGH administered as daily subcutaneous injections in a dose of 0.5-0.7 IU/kg/week reach their genetic growth potential, resulting in a normalisation of height in the majority of them, irrespective of spontaneous or induced puberty.     

Trend in Height of Turkish and Moroccan Children Living in The Netherlands

ObjectivesTo study trends in height of Turkish and Moroccan immigrant children living in The Netherlands, to investigate the association between height and background characteristics in these children, and to calculate height-for-age-references data for these groups.DesignNationwide cross-sectional data collection from children aged 0 to 18 years by trained professionals in 1997 and 2009. The study population consisted of 2,822 Turkish 2,779 Moroccan, and 13,705 Dutch origin children in 1997and 2,548 Turkish, 2,594 Moroccan, and 11,255 Dutch origin children in 2009. Main outcome measures: Mean height in cm, and mean height standard deviation scores.ResultsIn 2009, mean height at the age of 18y was similar for Turkish and Moroccan children: 177 cm for boys and 163 cm for girls, which was 2 to 3 cm taller than in 1997. Still, Turkish and Moroccan adolescents were 5.5 cm (boys) to 7 cm (girls) shorter than their Dutch peers. No significant differences were found in mean height standard deviation scores across the educational level of the parents, geographical region, primary language spoken at home, and immigrant generation.ConclusionsWhile the secular height increase in Dutch children came to a halt, the trend in Turkish and Moroccan children living in The Netherlands continued. However, large differences in height between Turkish and Moroccan children and Dutch children remain. We found no association with the background characteristics. We recommend the use of the new growth charts for children of Turkish and Moroccan origin who have a height-for-age below -2SD on the growth chart for Dutch children.     

A survey on growth and sexual development of adolescent students in Changhua City: growth of body height and weight

In order to understand the physical growth and sexual development of contemporary adolescents, a cross-sectional survey was conducted during the period September 1983 to May 1984. The population came from all the pupils from 4th grade up, and all the junior and senior high students of Changhua City. By using stratified cluster sampling, 1419 boys and 1599 girls participated, ranging in age from 8 to 19 years. Body weight and height were measured. Growth spurt is a unique event during adolescence. It is well shown in the distance curves and pseudo-velocity curves of body height and weight. In boys, the growth spurt of height spanned from 12.0 to 14.8 years, with peak height velocity (PHV) at 13.5 years. In girls it was from 10.0 to 12.6 years and peaked at 11.5 years. The growth spurt of weight occurred from 12.0 to 15.9 years in boys with peak weight velocity (PWV) at 14.5 years, while girls had a growth spurt at 10.0-12.7 years with PWV at 11.5 years. Girls entered into the growth spurt about 2 years earlier, and also entered into PHV, PWV, two and three years earlier respectively than boys, while boys had a more intense and longer growth during the growth spurt than girls. Between 10.0-13.0 years girls were taller than boys, and between 12.0-13.0 years they were heavier than boys. However, from 13.5 years onward girls were soon surpassed by boys both in height and weight. Growth in height after 16.5 years in boys and after 15.5 in girls was minimal. Growth in weight in boys also became minimal after 16.5 years while girls weight even dropped a little bit after 16.5 years. At the mean age of 17.5 years, boys were 168.1 cm, girls were 156.2 cm in average, boys being 12 cm taller than girls after reaching their final height.     

Construction of a New Growth References for China Based on Urban Chinese Children: Comparison with the WHO Growth Standards

Introduction

Growth references for Chinese children should be updated due to the positive secular growth trends and the progress of the smoothing techniques. Human growth differs among the various ethnic groups, so comparison of the China references with the WHO standards helps to understand such differences.

Methods

The China references, including weight, length/height, head circumference, weight-for-length/height and body mass index (BMI) aged 0–18 years, were constructed based on 69,760 urban infants and preschool children under 7 years and 24,542 urban school children aged 6–20 years derived from two cross-sectional national surveys. The Cole’s LMS method is employed for smoothing the growth curves.

Results

The merged data sets resulted in a smooth transition at age 6–7 years and continuity of curves from 0 to 18 years. Varying differences were found on the empirical standard deviation (SD) curves in each indicator at nearly all ages between China and WHO. The most noticeable differences occurred in genders, final height and boundary centiles curves. Chinese boys’ weight is strikingly heavier than that of the WHO at age 6–10 years. The height is taller than that of the WHO for boys below 15 years and for girls below 13, but is significantly lower when boys over 15 years and girls over 13. BMI is generally higher than that of the WHO for boys at age 6–16 years but appreciably lower for girls at 3–18 years.

Conclusions

The differences between China and WHO are mainly caused by the reference populations of different ethnic backgrounds. For practitioners, the choices of the standards/references depend on the population to be assessed and the purpose of the study. The new China references could be applied to facilitate the standardization assessment of growth and nutrition for Chinese children and adolescents in clinical pediatric and public health.     

Estimating final height from parental heights and sex in Taiwanese

We have developed a simple function for accurately estimating target height for use in evaluating growth and growth-promoting therapies in Taiwanese children. The heights of parents and their adult offspring born in the 1970s were determined in 1229 healthy families who accompanied another family member to our pediatric clinic. We directly measured the heights of the population-based cohort of adult offspring. The heights of their parents were based on self-report. Both the parents and their offspring were healthy. The increases in height between the two generations were 1.49-3.19 cm for boys and 2.03-2.61 cm for girls. These increases lie between those reported for Chinese children in Hong Kong (4.2-4.8 cm) and children in Sweden (0.7-1.0 cm). Final height was underestimated using the corrected midparental height method and was overestimated using the final parental height model developed from Swedish data. We developed a new linear model by fitting our data: boy height = 79.3 + 0.56 (midparental height); girl height = 35.2 + 0.76 (midparental height). The intercept and slope of the model are similar to those reported for Swedish girls but not to those reported for Swedish boys. Use of the new equations derived from our data may increase the accuracy of estimates of target height in Taiwanese children. The intermediate position of our fairly representative Taiwanese sample in both final height and generational increases in final height may reflect an intermediate stage between the Swedes and Hong Kong Chinese in the secular trend of heights.     

Healthy growth in children with Down syndrome

Objective

To provide cross-sectional height and head circumference (HC) references for healthy Dutch children with Down syndrome (DS), while considering the influence of concomitant disorders on their growth, and to compare growth between children with DS and children from the general population.

Study design

Longitudinal growth and medical data were retrospectively collected from medical records in 25 of the 30 regional hospital-based outpatient clinics for children with DS in the Netherlands. Children with Trisomy 21 karyotype of Dutch descent born after 1982 were included. The LMS method was applied to fit growth references.

Results

We enrolled 1,596 children, and collected 10,558 measurements for height and 1,778 for HC. Children with DS without concomitant disorders (otherwise healthy children) and those suffering only from mild congenital heart defects showed similar growth patterns. The established growth charts, based on all measurements of these two groups, demonstrate the three age periods when height differences between children with and without DS increase: during pregnancy, during the first three years of life, and during puberty. This growth pattern results in a mean final height of 163.4 cm in boys and 151.8 cm in girls (−2.9 standard deviation (SD) and −3.0 SD on general Dutch charts, respectively). Mean HC (0 to 15 months) was 2 SD less than in the general Dutch population. The charts are available at www.tno.nl/growth.

Conclusions

Height and HC references showed that growth retardation in otherwise healthy children with DS meanly occurs in three critical periods of growth, resulting in shorter final stature and smaller HC than the general Dutch population shows. With these references, health care professionals can optimize their preventive care: monitoring growth of individual children with DS optimal, so that growth retarding comorbidities can be identified early, and focusing on the critical age periods to establish ways to optimize growth.     

儿童身高生长追踪研究

以北京市106名儿童为样本 ,为研究各年龄生长速度的集中趋势、变异状况以及与生长速度有关的参数 ,追踪观察这些儿童自6、7岁至 18岁时共12年的身高变化 ,并做有关参数分析。报告了各年龄组身高生长速度的均值及标准差 ,该组儿童身高生长突增开始年龄 (男10.73±1 .12岁 ,女 9.00± 1.18岁 )及速度 (男4.51± 0.65cm/年 ,女 4.95± 0.79cm/年 ) ;身高生长高峰发生年龄 (男 1 3.0 7±1.08岁 ,女11.32± 1.32岁 )及速度高峰值 (男10 .01± 1.59cm/年 ,女8.13± 1.03cm/年 ) ;以及生长突增结束年龄 (男16.18± 1.02岁 ,女 13.96± 1.09岁 )。分析了最终身高与生长突增有关指标的相关关系。     

Final height of growth hormone-treated GH-deficient children and girls with Turner's syndrome: the Dutch experience. The Dutch Advisory Group on Growth Hormone

In the Dutch growth hormone (GH) registration database there are currently 552 GH-deficient children being treated, subcutaneously, with recombinant human GH six to seven times per week. Of those, 112 who have been treated for at least 2 years have reached final height. Mean age at start of therapy was 11.70 years. Mean GH dose was 15.5 IU/m(2) body surface per week. Mean final height was 173.2 cm (boys) and 159.7 cm (girls) and -1.36 SD of the population mean. Of the patients, 73.2% and 63.4%, respectively, reached a final height above -2 SD of the population or within target limits. FH-SDS was higher compared with the results of earlier cohorts with different treatment regimens. Target height, GH peak value at diagnosis, age at start of GH therapy, height SDS (HSDS) at start of puberty, and duration of GH therapy were significantly correlated with final height. These results, combined with those of a prospective GH dose-response study, suggest that better long-term results can be obtained with early and prolonged treatment and if the GH dose is individually adapted to the short-term growth response. In an ongoing dose-response study, 68 girls with Turner's syndrome, aged 2-11 years, were randomized into three dosage groups with a daily GH dose of: (group A) 4 IU/m(2) body surface; (group B) 4 IU/m(2) in the first year of therapy and 6 IU/m(2) thereafter; (group C) 4 IU/m(2) in the first year, 6 IU/m(2) in the second year, and 8 IU/m(2) thereafter. After 4 years of GH therapy, girls aged 12 years or older started low-dose oestrogen therapy. After 7 years of GH therapy, mean HSDS in all three groups had increased to values above the third percentile for healthy girls. Mean final height and final height gain of 25 girls was 159.1 and 12.5 cm, 161.8 and 14.6 cm, and 162.7 and 16.0 cm in groups A, B and C respectively. These long-term and final height results are more favourable than the results of earlier Dutch Turner's syndrome studies. Possible explanations are the higher GH doses and/or the younger age at start of GH therapy.     

Maxillary volume growth in childhood

Nasomaxillary abnormalities in form, position, and development in children are often prominent features of craniosynostosis, and in particular, craniofacial dysostosis. While attempting to quantitatively assess the volumetric maxillary deficiency in these patients, it became apparent that there was no "normal" reference range for maxillary volumes throughout childhood that could be used for comparison. The aim of this study was to generate a model for measuring maxillary volume and subsequent changes throughout childhood. The technique of segmentation was applied to magnetic resonance images obtained in 55 healthy children (30 boys, 25 girls), aged 1 month to 184 months (15.33 years). Maxillary volumes were plotted against age for boys and girls to create a model for normal maxillary growth during the first 15 years of life. Maxillary volumes were larger in boys at all ages. However, the pattern of maxillary growth in boys and girls was similar and could be divided into three periods, each lasting approximately 5 years. During the first 5 years of life, there is a steady increase in maxillary volume, at the end of which the maxilla has reached 53 percent of the volume recorded at 15 years. There is an accelerated rate of growth between 5 and 11 years, which corresponds to the development and eruption of the permanent dentition. Thereafter, until the age of 15 years, the rate of growth of the maxilla plateaus. Maxillary volume in the first 12 months of life is, on average, 29 cm3 in boys and 25 cm3 in girls. By 15 years of age, it has increased to an average of 73.0 cm3 in boys and 59.4 cm3 in girls (an increase by a factor of 2.5 in boys and 2.4 in girls). The difference between the two sexes is statistically significant for the entire series (boys: mean maxillary volume = 56.55 cm3, SD = 24.61; girls: mean maxillary volume = 40.68, SD = 17.69, p = 0.009, one-way analysis of variance).     

Growth response to growth-hormone administration during the decelerating phase of the pubertal growth spurt in short normal children

In order to investigate the value of growth hormone (GH) treatment during late puberty, we studied the effect of human GH (hGH) administration (0.85 +/- 0.30 IU/kg/week; range: 0.44-1.28) on height velocity (HV) after the peak of the pubertal growth spurt in a group of 10 (4 girls and 6 boys) short normal children (GH peak after pharmacological stimulation: 15.5 +/- 2.3 ng/ml) with growth retardation (height: 2.6 +/- 0.3 SD) and puberty Tanner stage 4. A group of 10 untreated children, observed prior to the study, served as controls. The children were regularly measured during their pubertal growth spurt, and HV (cm/year) was calculated every 6 months. The pretreatment evaluation consisted of 2 consecutive 6-month periods characterized by a decrease in HV of at least 25%. In the group of selected children, hGH administration was then initiated and growth variables were evaluated after 6 and 12 months of therapy. Skeletal maturation was evaluated at the beginning as well as after 6 months and 12 months of hGH therapy. In the controls, HV (mean +/- SD) had decreased from 8.8 +/- 1.8 to 4.9 +/- 1.4 cm/year during the pretreatment period (in girls from 7.9 +/- 1.4 to 4.1 +/- 0.6 cm/year and in boys from 9.6 +/- 1.6 to 5.8 +/- 1.2 cm/year). During the following semester, HV was 3.3 +/- 0.8 cm/year (girls: 3.4 +/- 1.0 and boys: 3.2 +/- 0.2 cm/year).(ABSTRACT TRUNCATED AT 250 WORDS)     

Growth hormone treatment in short Japanese children born small for gestational age

Recent reports have shown that high-dose growth hormone (GH) treatment in short children born with small for gestational age (SGA) resulted in a pronounced acceleration of linear growth. We describe the results of multicenter trials of recombinant human GH (rhGH) treatment in short SGA children in Japan. Two clinical studies were performed and the results were combined. Study 1 comprised 104 SGA children and study 2 comprised 61 SGA children. The patients were divided into three groups: group 1 consisted of 20 patients (13 boys and 7 girls) who received rhGH 25 microg/kg per day six or seven times per week in the first year and 50 microg/kg per day in the second year and thereafter; group 2 consisted of 48 patients (28 boys, 20 girls) who received rhGH 45/50 microg/kg per day; group 3 consisted of 44 patients (28 boys, 16 girls) who received 90/100 microg/kg per day. The mean increments in height SDS were 0.46, 0.67 and 0.94 SD in boys and 0.49, 0.79 and 0.93 SD in girls in groups 1, 2 and 3, respectively. The mean increment in height SDS at 2 years in group 3 was significantly greater than that in group 1, but it was not significantly different from that in group 2 in boys and girls. Our data demonstrated that high-dose GH administration significantly improved height velocity and height SDS in short SGA children. Additional studies are necessary to optimize a long-term GH treatment regimen and combined luteinizing hormone releasing hormone analog treatment for final height. Careful observation is also necessary to assess the metabolic effects of high-dose GH, especially on carbohydrate metabolism.     

Growth charts for Croatian school children and secular trends in past twenty years

The aim of this study was to construct new Croatian growth charts for body height and weight of boys and girls aged 6.5 to 18.5 years and to investigate differences between our and pre-existing studies. Analysis was based on a multistage stratified sample representative for school children aged 6.5 to 18.5, 6046 boys and 5656 girls. Growth reference was constructed using LMS method. Present results demonstrated an increment of body height and weight during the last two decades. Highest increase of body height is in boys aged 13-14 years 6.5 cm, in girls aged 12 years is 5.0 cm. Highest increase of body weight is in 16 year age group of boys 8.7 kg and in 11-12 year age group of girls 5.2 kg. In conclusion, regarding presence of secular trend because previously used growth charts in Croatia are obsolete.     

Sex differences in weight in infancy and the British 1990 national growth standards.

OBJECTIVES: To determine if there is a sex difference in infancy in the new British national standards for weight (based on data from 1990). DESIGN: Weight data in a birth cohort were compared with the 1990 standards and Tanner and Whitehouse (1966) standards up to age 12 months. SETTING: Newcastle upon Tyne. SUBJECTS: 3418 term infants. RESULTS: Our cohort showed a mean difference in standard deviation scores of 0.42 between boys and girls (P < 0.0001) when compared with the 1990 standards. Two and a half times as many girls as boys had weights below the 3rd centile during the first year, with an equivalent excess of boys above the 97th centile (P < 0.0001). Similar results were found with Tanner and Whitehouse standards. CONCLUSIONS: These differences could result in substantial sex bias in the identification of poor growth in early childhood. The standards need modification.     

Somatic growth of a school-aged population from Mozambique: trend and biosocial meaning

A cross-sectional study of children and adolescents from Maputo, Mozambique, was carried out in order to (1) describe the current growth status of children and adolescents from Maputo, (2) evaluate the relative status of the growth and development of youth from Maputo compared to WHO international standards, (3) assess the relationship between socioeconomic status and growth and development, and (4) assess the impact that the civil war (1980-1992) had on the health status of children and adolescents living in Maputo. The sample is composed of 2,271 subjects (1,098 boys and 1,173 girls), age 6 to 17 years. Somatic measures included height, weight, and skinfold thicknesses from which nutritional indicators were calculated and plotted against WHO norms. Subjects were divided into three groups according to their socioeconomic status. Data from a cross-sectional study done in the same areas in 1992 was used to analyze the impact of war. Beginning at 11 years, Maputo students are always shorter and weigh less than the WHO standards. BMI in boys from 11 years and in girls from 12 years is somewhat lower than the WHO norms. A social gradient is evident, favoring those students with higher socioeconomic status. Height, weight, BMI, fat mass, and lean body mass are always higher in the 1999 sample than in the 1992 study. We conclude that (1) there is a substantial difference in height and weight values of Maputo children and adolescents compared to WHO standards; (2) there is a clear advantage of being of higher socioeconomic status; (3) socioeconomic status, hygiene, and sanitation are the main factors responsible for the greater values of the 1999 sample; and (4) differences between the stature of students with higher socioeconomic status and the WHO norms are almost irrelevant. This last aspect reveals the importance of socioeconomic factors in determining the growth process, implying its importance in facilitating the "expression" of the genotypes available in the population.     

Household wealth and gender gap widening in height: Evidence from adolescents in Ethiopia,India, Peru,and Vietnam

This study investigates the relationship between household wealth and child height utilizing longitudinal data on 7150 children from Ethiopia, India, Peru, and Vietnam. The concept of conditional wealth is applied to separate the influence of wealth in early childhood. Conditional wealth is the change in wealth that was unpredicted at the age of 5 years. This study finds two dimensions of heterogeneity in the wealth-gradient of adolescent height: gender and stunting status at the age of 5 years. For all four countries in the study, the effect of conditional wealth on adolescent height is stronger for boys than for girls. The estimates for the pooled sample indicate that after the age of 5 years, the growth of children who were stunted at that age is significantly more responsive to conditional wealth than the growth of non-stunted children. The analysis results show that for boys in Ethiopia, a one-standard-deviation increase in preadolescence wealth is associated with an increase of 1 cm (standard error [SE]: 0.3) in height at the age of 15 years. For boys in the Indian state of Andhra Pradesh, Peru, and Vietnam, the corresponding figures are 1.1 cm (SE: 0.4), 1.8 cm (SE: 0.4), and 1.2 cm (SE: 0.4), respectively. The effect of preadolescence wealth on adolescent height is not statistically significant for girls, except in some regions. Overall, the results suggest that household wealth in preadolescence disproportionately benefits the male population in these countries when using height as a proxy for health.     

Total pubertal growth and markers of puberty onset in adolescents with GHD: comparison between mathematical growth analysis and pubertal staging methods

Two methods of determining puberty onset (Preece- Baines model 1 (PB1) and Tanner staging) were used to calculate total pubertal growth (TPG) in adolescents with growth hormone deficiency (GHD). PATIENTS AND METHODS: 34 patients (11 girls) met the following inclusion criteria: isolated GHD, >2 years growth hormone therapy prior to puberty onset, regular weight-adjusted GH dosage, known final height (age >21 years or height velocity <0.5 cm/year), no induction of puberty. PB1 was used to define age and height at onset of the pubertal growth spurt ("take-off"). RESULTS: The results (mean +/- SD) were as follows: in girls, mean age at take-off was 9.8 years; 2.0 +/- 1.1 years before breast stage B2. In boys, mean age at take-off was 11.3 years; 1.4 +/- 0.8 years before testes volume >3 ml. Height at take-off was lower than at Tanner stage 2 by 12.4 +/- 7.6 cm in girls and 7.7 +/- 5.3 cm in boys. TPG was thus markedly greater (p < 0.001) using the PB1 method, as compared with Tanner stage2. Peak height velocity was normal. Final height was -0.5 +/- 0.7 SDS in females and -0.4 +/- 0.9 SDS in males. CONCLUSIONS: The method of measuring TPG from take-off is more objective, and has potentially greater implications for GH therapeutics than the Tanner stage method. In our study, 40% of TPG occurred before "breast stage B2" was attained in GHD girls; whereas 23% of TPG occurred before "testes >3 ml" in GHD boys.     

Estimating height from arm span measurement in Malawian children

Arm span and standing height were measured in 289 boys and 337 girls aged 6-15 years who were free from physical deformities which can affect stature or arm span. The arm span exceeded height in all age groups of boys and in older girls. At the age of 7, 11 and 12 years girls were significantly taller than the boys and had longer arm span while at the age of 15 years, the trend was opposite. The mean difference between the two anthropometric parameters for boys was 5.45 +/- 4.21 cm (t = 3.556, p < 0.001) and for girls was 4.94 +/- 4.96 cm (t = 3.542, p < 0.001). Correlation coefficient between height and arm span measurements for Malawian boys was 0.983 and for girls was 0.986. Height, arm span and height-arm span difference increased with age of children while height to arm span ratio decreased. The gender difference in height-arm span differences was only significant at the age of 15 years. Multiple regression and cross validation were performed. Height of Malawian children of both sexes can be estimated from equation: Height (cm) = 15.756 + (0.168 x age) + (0.839 x arm span) (SEE = 0.760, R2 = 0.988).     

Causes of precocious puberty in children referred for evaluation in hospital conditions

INTRODUCTION: Symptoms of precocious puberty (PP) in children always arouse anxiety in their parents. Many children with PP are being hospitalized for the detailed diagnostic work-up. The aim of our study was to analyze the frequency of the variants of PP in children referred to our department. MATERIAL: Retrospective analysis of 119 children (103 girls and 16 boys) referred for hospitalization in the years 2003-2005 due to signs of precocious puberty was performed. RESULTS: Premature thelarche, benign variant of puberty, was diagnosed in 62 (53%) girls, in the mean age of 3.39 (+/- 2.33) years. Their mean height was within 0.7 +/- 1.1 SD. Premature pubarche was diagnosed 30 (25%) children--22 girls and 8 boys in the mean age was 7.24 (+/- 0.81) years. Their mean height was 1.3 +/- 1.0 SD and was significantly higher than normal (p < 0.0001). Premature menarche was diagnosed in 8 (7%) girls in the mean age 4.81 +/-2.26 years. Mean height in this group was normal for age (0.9+/-0.8 SD). PP was diagnosed in 19 (16%) children (11 girls and 8 boys) in the mean age 5.91 +/- 1.63 years. Mean height in this group was 1.6 +/- 0.7 SD, and was significantly higher than the mean for age (p<0.0005). GnRH-dependent type was present in 15 children, diagnosed as idiopathic in 9 girls and 1 boy. In 5 children (4 boys and 1 girl) pathology of central nervous system was found. In 4 children GnRH-independent precocious puberty was diagnosed--in 3 caused by congenital adrenal hyperplasia and in 1 boy by tumour of testis (leydigioma). CONCLUSIONS: Girls with precocious thelarche without growth acceleration present the benign variant of puberty and need clinical follow up only. Boys with clinical signs of precocious puberty should be carefully evaluated to rule out the organic cause.