Xhrouet-Heinrichs D, Lagrou K, Heinrichs C, Craen M, Dooms L, Malvaux P, Kanen F, Bourguignon J P
Department of Pediatrics, University of Brussels, Belgium.
Acta Paediatr. 1997 Aug;86(8):808-15. doi: 10.1111/j.1651-2227.1997.tb08602.x.
The aim of the present study was to evaluate the behavioral and affective characteristics and the changes in psychosocial functioning resulting from precocious puberty in 15 girls with central precocious puberty treated for 2 y using the GnRH agonist long-acting triptorelin, and in 5 untreated girls. After diagnosis of precocious puberty at 6.6-10.4 y of age, height, weight and pubertal development were evaluated at 3-month intervals over 2 y. Semi-structured interviews were carried out with the patient, the parents and the pediatric endocrinologists at 1, 8, 16 and 24 months after diagnosis. Standardized questionnaires (Child Behavior Checklist, Self-esteem Inventory) were administered at 1 and 24 months or 16 and 24 months, respectively. There was a mean 1.5-y delay between the observation of signs of puberty as reported by the parents and the diagnosis of precocious puberty at the first consultation of a pediatric endocrinologist. Before follow-up, all 20 girls were very concerned about physical differences from peers, particularly breast development. During therapy, breast regression to minimal or absent development occurred in 5/15 treated patients, who then no longer felt embarrassed about pubertal development in contrast to the other patients. Fear of sexuality remained obvious throughout the study in most patients. Feelings of loneliness and exemplary behavior were observed and tended to decrease in the treated patients and to increase in the untreated patients. Elevated scores of withdrawal, anxiety/depression and somatic complaints at Child Behavior Checklist were still observed after 2 y. These changes in behavioral and affective characteristics appeared to be related neither to height and weight, nor to development of pubic hair, which progressed in most patients. After 2 y, the physical differences remained a concern for 13 girls and the risk of short adult stature for 6. In summary, some behavioral and affective characteristics and particularities in psychosocial functioning are observed in girls with precocious puberty. During treatment with long acting triptorelin, problematic behavior and functioning decrease slightly, particularly in the few girls showing breast regression to minimal or absent development.
本研究的目的是评估15名接受促性腺激素释放激素（GnRH）激动剂长效曲普瑞林治疗2年的中枢性性早熟女孩和5名未治疗女孩的行为和情感特征，以及性早熟导致的心理社会功能变化。在6.6至10.4岁诊断为性早熟后，在2年期间每隔3个月评估身高、体重和青春期发育情况。在诊断后1、8、16和24个月，对患者、家长和儿科内分泌专家进行了半结构式访谈。分别在1和24个月或16和24个月发放标准化问卷（儿童行为量表、自尊量表）。家长报告的青春期体征出现与儿科内分泌专家首次会诊时性早熟诊断之间平均延迟1.5年。在随访前，所有20名女孩都非常关注与同龄人身体上的差异，尤其是乳房发育。治疗期间，15名接受治疗的患者中有5名乳房消退至最小发育或无发育，与其他患者相比，她们不再因青春期发育而感到尴尬。在整个研究过程中，大多数患者对性的恐惧仍然很明显。观察到有孤独感和模范行为，接受治疗的患者中这些情况有减少趋势，未治疗的患者中有增加趋势。2年后，儿童行为量表上退缩、焦虑/抑郁和躯体不适的得分仍较高。这些行为和情感特征的变化似乎既与身高和体重无关，也与大多数患者持续进展的阴毛发育无关。2年后，13名女孩仍担心身体差异，6名女孩担心成年后身材矮小。总之，性早熟女孩存在一些行为和情感特征以及心理社会功能方面的特殊性。在用长效曲普瑞林治疗期间，问题行为和功能略有减少，尤其是在少数乳房消退至最小发育或无发育的女孩中。
