Schoelwer Melissa J, Donahue Kelly L, Bryk Kristina, Didrick Paula, Berenbaum Sheri A, Eugster Erica A
Pediatrics, Section of Pediatric Endocrinology, Riley Hospital for Children, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN 46202 USA.
Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN USA.
Int J Pediatr Endocrinol. 2015;2015(1):5. doi: 10.1186/s13633-015-0001-7. Epub 2015 Mar 16.
Concerns about psychological distress are often used to justify treatment of girls with precocious puberty, but there is little evidence to support these concerns. The extent to which psychological problems are associated with central precocious puberty (CPP) compared with other forms of early puberty in girls has likewise not been established.
Girls presenting with untreated CPP, premature adrenarche (PA) or early normal puberty (ENP) were recruited from our pediatric endocrine clinic along with their mothers. Child psychological adjustment was assessed by child self-report and parent report. Parent self-reported personality, anxiety, and depression were also assessed. Differences between groups were explored using one-way ANOVA and Dunnett's T3 test.
Sixty-two subjects (aged 7.5 ± 1.4 years, range 4.8-10.5) were enrolled, of whom 19 had CPP, 22 had PA, and 21 had ENP. Girls with ENP were significantly older (8.9 ± .9 years) than girls with CPP (6.9 ± 1.1 years, p < .001) and PA (6.6 ± 1.0 years, p < .001). Girls with PA had significantly higher BMI z-scores (1.7 ± .8) than girls with CPP (1.1 ± .6, p = .01) and ENP (1.2 ± .6, p = .04). More girls with PA and ENP were from racial minorities (47% and 50% respectively) than girls with CPP (32%). No group differences were found for any child measure of psychological adjustment. However, mothers of girls with PA scored significantly higher than mothers of girls with ENP on one measure of depression (p = .04) and stress (p = .01).
While mothers of girls with PA report increased psychological distress on some measures, no differences in psychological adjustment were found at baseline amongst the girls themselves. Whether these results will change as puberty progresses in the PA and ENP groups or with treatment of CPP is unknown. Long-term prospective studies are needed in order to further investigate psychological correlates of early puberty in girls.
对心理困扰的担忧常被用作治疗性早熟女孩的理由，但几乎没有证据支持这些担忧。与女孩其他形式的性早熟相比，心理问题与中枢性性早熟（CPP）的关联程度同样尚未明确。
从我们的儿科内分泌诊所招募了患有未经治疗的CPP、早熟肾上腺皮质功能初现（PA）或早期正常青春期（ENP）的女孩及其母亲。通过儿童自我报告和家长报告评估儿童的心理适应情况。还评估了家长自我报告的性格、焦虑和抑郁情况。使用单因素方差分析和邓尼特T3检验探索组间差异。
共纳入62名受试者（年龄7.5±1.4岁，范围4.8 - 10.5岁），其中19名患有CPP，22名患有PA，21名患有ENP。患有ENP的女孩（8.9±0.9岁）比患有CPP的女孩（6.9±1.1岁，p<0.001）和患有PA的女孩（6.6±1.0岁，p<0.001）年龄显著更大。患有PA的女孩的BMI z评分（1.7±0.8）显著高于患有CPP的女孩（1.1±0.6，p = 0.01）和患有ENP的女孩（1.2±0.6，p = 0.04）。与患有CPP的女孩（32%）相比，患有PA和ENP的女孩中更多来自少数族裔（分别为47%和50%）。在任何儿童心理适应测量中均未发现组间差异。然而，在一项抑郁测量（p = 0.04）和压力测量（p = 0.01）上，患有PA的女孩的母亲得分显著高于患有ENP的女孩的母亲。
虽然患有PA的女孩的母亲在某些测量中报告心理困扰增加，但在基线时女孩自身之间未发现心理适应方面的差异。随着PA和ENP组女孩青春期的进展或CPP的治疗，这些结果是否会改变尚不清楚。需要进行长期前瞻性研究以进一步调查女孩性早熟的心理相关因素。
