Determination of The Frequency of Precocious Puberty in Manisa Region

Precocious puberty is described as the appearance of puberty findings before the age of eight in girls, and age of nine in boys. During the recent years, it has been shown in many research that onset of puberty has shifted to earlier ages. The aim of this study was determination of the frequency of precocious puberty in Manisa region. To evaluate the frequency of precocious puberty, 803 students aged between 6 and 11 years in first, second and third grades of Manisa Center Primary Schools were screened. 359 children were girls (44,7%) while 444 children were boys (55,3%). Weights and heights of children were measured during the screening. Puberty stages were determined on the basis of Tanner puberty stages. Bone ages of 40 children randomly selected among the ones with precocious puberty and 40 children randomly selected among the ones without puberty were assessed as well as their serum levels of estradiol, free testosterone, total testosterone, inhibin B, insulin like growth hormone binding protein-1 (IGFBP-1), insulin and 17hydoxyprogesteron (17OHP). Moreover, pelvic ultrasonography (USG) was performed in girls to establish dimensions of the ovaries and uterus and scrotal USG was performed in boys to establish testis volumes. Evaluation of all children included in the study revealed that the frequency of precocious puberty was 10% according to the Tanner puberty stages. Evaluation of precocious puberty according to gender revealed that frequency of precocious puberty among girls (10.9%) was higher than that of boys (9.2%). It was found that precocious puberty was more frequent among children of working mothers and mothers with higher educational levels. (p<0.05). There was no relationship between precocious puberty and paternal occupation or education ( p>0.05). Evaluation of 803 children included in the study revealed that, mean weight and height were significantly higher in Tanner stage 2 when compared to those in stage 1 (p<0.05). No difference was detected between the two groups in terms of body weight standard deviation score (BW SDS), body mass index (BMI), BMI SDS and height SDS (p>0.05). Comparison of the anthropometric properties of the precocious puberty and control groups included in the study revealed that height and height SDS were significantly higher in the precocious puberty group (p<0.05). Weight, BW SDS, BMI and BMI SDS was not significantly different between the two groups (p>0.05). Mean age of the precocious puberty group was 8.52±0.84, while that of the control group was 8.53±0.87. Comparison of the bone ages in precocious puberty and control groups failed to demonstrate a significant difference (p>0.05). Estradiol levels of girls in the precocious puberty group were higher than those in the control group but this difference was not statistically significant. Inhibin B and 17OHP levels were not significantly different between the two groups (p>0.05). Total testosterone, free testosterone and 17OHP levels of the boys in the precocious puberty and control groups were not different but inhibin B was found to be significantly higher in precocious puberty group. A weak negative correlation was detected between inhibin B and total testosterone levels in precocious puberty levels but was not found to be statistically significant (r=-0,189, p=0,426). Inhibin B and total testosterone was found to be negatively correlated in the control group but was not statistically significant (r= - 0,097, p=0.69). Insulin levels of both girls and boys in the precocious puberty group were higher than those of the control group but this difference was not statistically significant. IGFBP-1 levels of girls in the precocious puberty group was lower than those of the control group but the difference was not statistically different (p>0.05). In boys, IGFBP-1 levels were not different between the precocious puberty and control groups (p>0.05). Insulin levels were higher and IGFBP-1 levels were lower in the obese group when compared to the non-obese group however the difference in these parameters was not statistically significant (p>0,05). In both precocious puberty and control groups, inhibin B levels showed moderately positive correlation with testis volumes in boys ( r=0,435, p=0.05 and r=0.044, p=0.86 respectively). In precocious puberty group, negative correlation existed between testosterone levels and testis volume in boys but was not found to be statistically significant (r=-0,292, p=0.21). On the other hand, in the control group, a weakly positive correlation was detected between testosterone levels and testis volume in boys but this was not significant either (r=0,137, p=0.58 ). Ovary dimensions in pelvic USG was higher in girls in the precocious puberty group than those in the control group but was not found to be statistically significant (p=0,41 ve 0.82). Uterus dimensions were not different between precocious puberty and control groups (p=0,88). Fundocervical ratio in the control group was lower than that in the precocious puberty group but this was not found to be statistically significant ( p=0,21). Right and left testis mean volumes of the boys in the precocious puberty group was significantly higher than the control group in scrotal ultrasonographic evaluation (p<0,05). Follicule cyst was detected in 90% of the 40 girls in the pelvic USG. Precocious puberty and control groups were not significantly different in terms of the frequency of follicule cyst (p>0.05). In conclusion, precocious puberty is more frequently seen in girls when compared to boys. Maternal education and occupation influence precocious puberty. Serum levels of inhibin B increase during early stages of puberty. Key Words: Precocious puberty, frequency, inhibin B