Incidence of central precocious puberty more than doubled during COVID-19 pandemic: Single-center retrospective review in the United States

Abstract

Background and aim of the studyThe frequency of new visits for precocious puberty increased during the Covid-19 pandemic in the pediatric endocrinology clinic at Rady Children's Hospital in San Diego, CA, US. A few recent studies have shown an increase in the frequency of Central Precocious Puberty (CPP) in other centers during this pandemic. This study evaluated the change in incidence of new CPP cases requiring treatment with GnRH agonist (GnRHa) at Rady Children's Hospital during the Covid-19 pandemic and compared it to pre-pandemic years.MethodsData were reviewed retrospectively to compare the number of visits of children newly diagnosed with CPP treated with GnRHa during the Covid-19 pandemic (5/2020–4/2021) and before the pandemic (5/2018–4/2019). Clinical and bone maturation data were evaluated as well as differences in timing from diagnosis to onset of treatment. The incidence of CPP requiring treatment for 5 years prior to the pandemic was also reviewed to evaluate for trends over time.ResultsA total of 92 subjects were included. During pre-Covid year, 28 children (1 boy, 27 girls) were treated with GnRHa for CPP out of 2,340 new endocrinology visits (1.2% of patients seen). During Covid-19 year, 64 children (7 boys, 57 girls) were treated out of 2,261 new visits (2.8%). The incidence of new CPP cases requiring GnRHa during the pandemic more than doubled compared to pre-pandemic. Age at onset of treatment, degree of bone age (BA) advancement, time from diagnosis to onset of treatment, and changes in BMI during the pandemic were not different from pre-pandemic.ConclusionCPP cases requiring GnRHa treatment significantly increased during the first year of the Covid-19 pandemic. This was not related to increased BMI or delay in onset of treatment. Age at diagnosis, degree of bone age advancement, and time from diagnosis to onset of treatment were all similar during the first year of the pandemic compared to the prior year.

Precocious puberty under stressful conditions: new understanding and insights from the lessons learnt from international adoptions and the COVID-19 pandemic

“…reported than double incidence of CPP in Turkish girls during the pandemic compared to the previous three-years; no significant increase in BMI SDS compared to the pre-pandemic period was reported ( 112 ), suggesting that factors other than increased BMI played a role in the development of CPP. Similar data have been reported in Korean ( 103 ), Turkish ( 115 , 117 ), Indian ( 116 ), Chinese ( 113 , 121 ), Spanish ( 114 ), Brazilian ( 120 ), Lebanese ( 125 ) and American girls ( 126 ) ( Table 1 ).…”

“…Worldwide many research groups ( 103 , 112 – 117 , 120 , 121 , 125 , 126 ) have reported similar results. For example, Acar et al.…”

“…This phenomenon appears to be global (4,110,111) with cases of precocious puberty increasing dramatically in every country after lockdown restrictions were lifted (103, 105,108,109,[112][113][114][115][116][117][118][119][120][121][122][123][124][125][126]. The first report of an increase in the number of outpatients with newonset CPP from January to May 2020 was from the Meyer Children's University Hospital in Florence, Italy, which reported a 2 fold increase compared with the same period in previous years.…”

COVID-19 pandemic phases and female precocious puberty: The experience of the past 4 years (2019 through 2022) in an Italian tertiary center

“…Recently, several centers of pediatric endocrinology worldwide, including ours, have observed a further significant increase in the number of girls presenting with precocious or early puberty since mid-2020 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). During this period, corresponding to the first wave of COVID-19 pandemic, the Italian government imposed a strict lockdown across the country, in order to reduce the transmission rate and to avoid hospital bed saturation.…”

Editorial: Stars and rising stars in pediatric endocrinology: 2022

“…Chioma et al. build on the hypothesis that the COVID-19 pandemic triggers pathological processes in humans ( 4 , 5 ) to report a higher prevalence of rapidly progressive central precocious puberty (CPP) in girls during the COVID-19 pandemic from 2019 to 2022. Their finding that the prevalence declined after the peak of the pandemic suggests that the SARS-CoV-2 virus, or pandemic-associated environmental and psychosomatic changes could play a role in triggering CPP in girls.…”