Timing of Pubertal Onset in Girls and Boys With Constitutional Delay
Timing of Pubertal Onset in Girls and Boys With Constitutional Delay
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DOI：
10.1210/clinem/dgab270
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发表时间：
2021-04-22
影响因子：
5.8
通讯作者：
Chan, Yee-Ming
中科院分区：
文献类型：
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作者：
Jonsdottir-Lewis, Elfa;Feld, Amalia;Chan, Yee-Ming
背景：是否用性类固醇治疗青春期延迟的儿童主要是基于患者、家庭和提供者的偏好。了解体质发育迟缓的儿童最终何时进入青春期将决定这一决定。目标、设计、设置、参与者和结果测量：为了估计和比较青春期发育迟缓的比率，我们进行了一项回溯性队列研究，通过回顾2000至2015年间某大型学术医学中心评估为青春期延迟的儿童的医疗记录，提取所有临床就诊的青春期状况数据，然后进行事件时间分析。结果：在392名女孩和683名男孩中，体质发育迟缓是最常见的原因，在32%的女孩和70%的男孩中发现。在97名女孩和243名男孩的子队列中，他们在一次或多次访问中处于青春期前，我们观察到青春期进入的年龄范围很广，女孩最高可达16岁，男孩最高可达17岁。青春期延迟的12至15.5岁女孩和13.5至16.5岁男孩在未来一年内进入青春期的概率在38%至74%之间。经数据处理后，男女青春期发育迟缓儿童的青春期进入率无差异。结论：体质发育迟缓儿童青春期发育迟缓的年龄范围很广，这对宪法发育迟缓只是正常变异的极端情况的观点提出了挑战。与患者和家属讨论处理方法时，应考虑这样一种可能性，即一些儿童可能需要在分娩后数年后才能进入青春期。
Context: The decision whether to treat a child with delayed puberty with sex steroids is primarily based on patient, family, and provider preference. Knowing when children with constitutional delay eventually enter puberty would inform this decision.Objective, Design, Setting, Participants, and Outcome Measures: To estimate and compare rates of pubertal entry, we conducted a retrospective cohort study by reviewing medical records of children evaluated for delayed puberty at a large academic medical center between 2000 and 2015, extracting data on pubertal status for all clinical visits, then conducting time-to-event analyses.Results: Of 392 girls and 683 boys with delayed puberty, constitutional delay was the most common cause, found in 32% of girls and 70% of boys. In a subcohort of 97 girls and 243 boys who were prepubertal at one or more visits, we observed a broad age range for pubertal entry, up to >16 years for girls and >17 years for boys. The probability of entering puberty within the next year for 12- to 15.5-year-old girls and 13.5- to 16.5-year-old boys with delayed puberty ranged between 38% and 74%. No differences in the rates of pubertal entry were seen between girls and boys after data harmonization.Conclusion: The broad range of ages at pubertal entry for children with constitutional delay challenges the concept that constitutional delay is merely an extreme of normal variation. Discussions with patients and families about management should consider the possibility that some children may need to wait years after presentation until puberty starts.