Evaluation of quality of life in children with precocious puberty

Introduction: Precocious puberty (PP) is defined as the onset of secondary sex characteristics 2,5 standard deviations before the population norms. Precocious puberty is typically defined as the onset of puberty before age 8 in girls and before age 9 in boys. Precocious puberty can be defined in three groups as central, peripheral and normal variant precocious puberty. Normal variant precocious puberty (NVPP) includes premature thelarche (PT), premature pubarche and premature menarche. During puberty physical, physiological, psychological and social changes are seen. This unexpected early changes may cause psychosocial effects in children and their parents. In this reason quality of life which include physical, mental and social belongings becomes an important. In the literature, there are very few studies addressing the effects of PP on quality of life, and there is no study comparing the quality of life of central puberty precocity (CPP) requiring treatment and PT cases followed up without treatment. Aim: The aim of this study was to investigate the quality of life of CPP patients who required treatment and PT patients who were followed up without treatment, and to compare the treatment and non-treatment groups among themselves and with healthy children. Material & Methods: A total of 193 children and their parents were included in the study. 59 children with CPP and 53 children with PT who were admitted to Ankara University Faculty of Medicine, Department of Pediatric Endocrinology and 81 healthy children without additional chronic diseases who were admitted to Ankara University Faculty of Medicine, Department of Pediatrics were included in this study. A questionnaire was applied to evaluate the sociodemographic characteristics that would affect the quality of life. The "The Pediatric Quality of Life Inventory (PedsQL) " was used to evaluate the quality of life. PedsQL is a brief measure that can be used in children between the ages of 2-18. The PedsQL can be completed by children and parents for 5-7 and 8-12 age groups. PedsQL evaluate total scale score, psychosocial health summary score (emotional, social and school functioning) and the physical health summary score. Higher scores indicate better health related quality of life. Descriptive statistics and correlation analyses were performed in SPSS 11.5 program and p<0,05 was accepted as the statistically significant. Results: The mean current age with CPP, PT and control group was 9,31±0,68 (median 9,43, min 7,76, max 10,51), 8,32±1,21 (median 8,54, min 5,14, max 10,6) and 8,59±1,35 (median 8,87, min 5,44, max 10,95) years respectively. The mean age at diagnosis was 7,11±1,26 (median 7,43, min 2,24, max 8,82) years in the CPP group, 6,70±1,38 (median 7,21, min 1,77, max 7,97) years in the PT group (p>0.05). Total follow-up time 2,19±1,22 (median 1,88, min 0,62, max 7,37) years in the CPP group, 1,62±1,35 (median 1,24, min 0,28, max 6,96) years in the PT group (p<0.001). In this study, no difference was found living place, type of house, number of people living at home, family type, and number of siblings between the SPP, PT, and control groups (p>0.05). Although there was a difference between the SPP and control groups of school type (p=0.005), there was no difference between the groups in terms of school success (p>0.05). There was no difference between the SPP, PT and control groups in terms of maternal and paternal age, education, job, employment status, comorbidity and income status (p>0.05). The PedsQL total scale score was 78,10±17,13, 79,35±11,54, and 79,52±14,65, the psychosocial health summary score was 78,86±16,83, 79,40±12,54 and 79,94±14,94, physical health summary score was 75,81±20,69, 79,41±15,04 and 78,25±17,52 in CPP, PT, and control group respectively. In the scale applied to the parents total scale score was 77,18±15,26, 80,78±11,84 and 79,96±12,71, psychosocial health summary score was 78,57±14,72, 81,91±12,52 and 81,12±12,98, physical health summary score was 73,03±21,74, 77,36±15,08 and 76,48±17,66 in CPP, PT and control group respectively. The PedsQL scores were similar in the three groups. Considering the scales applied to children and parents for CPP, PT and control groups, although the mean PedsQL score of the CPP group was found to be lower than PT and control groups, but no statistical difference was found (p>0.05). CPP, PT, and control groups PedsQL scores were found to be similar between the children and parents, except for school functionality, school functionality was found to be higher in the scale administered to parents (p=0.008). Discussion & Conclusion: In this study, PedsQL scores were found to be similar between the CPP, PT and control groups both children and parents. Evaluated sociodemographic data was similar between the CPP, PT and control groups helped to exclude other conditions that may affect the quality of life. Unlike previous studies, the effects of sociodemographic characteristics and treatment initiation on quality of life were investigated. The scale score of CPP lower than PT was thought that the treatment affected the quality of life negatively. But the lack of statistical significance weakened the relationship between treatment and quality of life. In this sense, it was concluded that more comprehensive studies are needed. Key Words: Pediatric Quality of Life Inventory, PedsQL, Precocious Puberty, Quality of Life