Emerging Trend of Central Precocious Puberty: A Retrospective Study of Cases Diagnosed Before and During the COVID-19 Pandemic in a Portuguese Tertiary-Level Hospital.

INTRODUCTION

In light of the recent evidence suggesting an increase in idiopathic central precocious puberty (ICPP) during the COVID-19 pandemic, this study aimed to assess the incidence of newly diagnosed ICPP cases and compare differences in demographic, anthropometric, and clinical characteristics pre-pandemic and during the pandemic.

METHODS

We conducted a retrospective study at a national reference pediatric endocrinology unit in Portugal to evaluate the proportion of referrals for precocious puberty (PP) and, within this group, the number of ICPP cases diagnosed before (group 1: January 2018 to March 2020) and during the pandemic (group 2: April 2020 to June 2022). Additionally, we compared the demographic, anthropometric, and clinical characteristics of ICPP patients between the two groups.

RESULTS

Out of 258 patients referred for PP, 20 were diagnosed with ICPP (19 girls and one boy). Sixteen cases were diagnosed during the pandemic, marking a significant increase (16 vs. 4, p = 0.023), especially among girls. Additionally, thelarche onset occurred earlier during the pandemic (6.9 vs. 7.3, decimal age (DA) in years, p = 0.035). Despite pandemic challenges, a prompt medical response was observed, with a shorter time from first visit to treatment (DA at the onset of treatment - DA at first visit: 0.19 vs. 0.79 years; p = 0.015). No other parameters showed significant differences. Referrals for PP during the pandemic were not significantly higher than pre-pandemic (144 of 904 vs. 114 of 758, p > 0.05).

CONCLUSION

This study revealed a significant four-fold increase in the diagnosis of ICPP during the pandemic, particularly among girls. Furthermore, in the pandemic group, thelarche onset was earlier, raising the question of whether increased parental presence at home contributed to heightened awareness of pubertal changes. Despite the challenges posed by the pandemic in terms of referrals and follow-up, these results point to efficient work that led to prompt treatment initiation without delays, unlike in other pathologies, as mainly observed in adults. Surprisingly, no significant increase in body mass index was observed, suggesting that other factors may be involved. To substantiate these findings and uncover additional potential contributing factors for the development of ICPP, a more extensive research effort is warranted.