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J Korean Med Assoc > Volume 52(12); 2009 > Article
Kim, Shin, and Lee: Observed Trends for an Earlier Onset of Puberty: When is the Need for Treatment Indicated?

Abstract

Globally, there is a secular trend toward earlier puberty and an increased final height at adulthood. In Korea, there is a trend toward an earlier menarche in girls but insufficient data to evaluate secular trends in boys. A significant increase in height was observed in Koreans aged 0~20 years during 1965~2005. This trend has diminished, but growth maturation has accelerated in infants and young children. Genetic and environmental factors including nutritional status (e.g., obesity) contribute to these changes. Central precocious puberty results from the accelerated activation of the hypothalamic-pituitary-gonadal axis. Although the cut-off age is controversial, clinical evaluations should be conducted on girls with pubertal onset occurring younger than 8 years, and on boys younger than 9 years at least until further prospective studies define the norms for Korea. Management of precocious puberty depends on the underlying etiology, as accelerated puberty can lead to a reduced final adult height. Depot forms of GnRH agonists (GnRHas) are the standard treatment for some patients with central precocious puberty. These agents can help restore the normal adult height in both girls and boys when it might be compromised by rapidly progressive precocious puberty. However, in girls with slowly progressive precocious puberty or with the onset of puberty at 8~9.9 years of age (early normal puberty), GnRHa treatment might offer no benefit for attaining normal height. There is little evidence on whether psychosocial problems are associated with precocious puberty or are improved by GnRHa treatment.

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Figure 1
Hormonal changes during puberty.
Abbreviations: CNS, central nervous system; LH, luteinizing hormone; LHRH, LH releasing hormone; GH, growth hormone
jkma-52-1189-g001-l.jpg
Figure 2
Distribution of timing of puberty in different condition.
jkma-52-1189-g002-l.jpg
Figure 3
Secular trend in mean height from 1965 to 2005 in Korean girls (A) and boys (B).
jkma-52-1189-g003-l.jpg
Figure 4
Secular differences corrected by investigation interval in mean height between 2005 and 1997 (shaded bar, solid line), and between 1997 and 1984 (open bar, dotted line) in Korean girls (A) and boys (B).
jkma-52-1189-g004-l.jpg
Figure 5
(A) Height velocity for American boys. Dash line, 50th centile for boys 2 SD of tempo early; chain line, 50th centile for boys 2 SD of tempo late, respectively (36). (B) Secular trend in the mean peak height velocity for boys based on the Swedish longitudinal studies (2).
jkma-52-1189-g005-l.jpg
Figure 6
Adult height of in girls treated with GnRH agonist for progressive central precocious puberty.
Abbreviations: TH; target height, iPAH; initial predicted adult height before treatment, FH; final adult height
jkma-52-1189-g006-l.jpg
Figure 7
Adult height of in girls with early puberty.
Abbreviations: TH, target height; iPAH, initial predicted adult height before treatment; FH, final adult height; Th(+), treated with GnRH agonist; Th(-), without treatment
jkma-52-1189-g007-l.jpg
Table 1
Korean data about menarcheal and brest development mean age (year)
jkma-52-1189-i001-l.jpg

*Invesgation year was assumpted: supported by research fund in 1992, and published in 1994

Abbreviations: Pub_year, publication year; Inv_year, year of investigation; ES, elementary school; MS, middle school; HS, high school; Un, university; BII, breast sexual maturation rate II; GII, genital sexual maturation rate II; Dr, doctor; KNHNES III, The third Korea national health and nutrition examination survey, 2005

Table 2
Secular trend of final height and puberty in Korea and Netherlands
jkma-52-1189-i002-l.jpg

Abbreviations: BII, breast sexual maturation rate II; GII, genital sexual maturation rate II; BV, breast sexual maturation rate V; GV, genital sexual maturation rate V

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