Publication: Çocuk Endokrinolojisi Kliniğine Prematür Pubarş Ya Da Hirsutizm Nedeniyle Başvuran Kız Olguların Etiyolojik Tanı ve Klinik Özelliklerinin Değerlendirilmesi
Abstract
ÖZET Amaç: Prematür pubarş ve hirsutizm toplumda görülme sıklığı yüksek olan iki klinik durumdur. Çalışmada Çocuk Endokrinolojisi Kliniğine prematür pubarş (PrP) ya da hirsutizm ile başvuran kız olguların ilk başvurudan son başvuruya kadar olan tüm anamnez ve klinik seyir bilgileri, antropometrik ölçümleri, muayene bulguları, hormonal değerleri, görüntüleme sonuçları incelenerek tanı dağılımlarını ortaya koymayı amaçladık. Gereç ve Yöntem: Ondokuz Mayıs Üniversitesi Çocuk Endokrinolojisi Polikliniği'ne 01 Ocak 2017-31 Aralık 2022 tarihleri arasında 270'i PrP, 135'i hirsutizm sebebiyle başvuran toplam 405 kız olgunun verileri hastane kayıtlarından geriye dönük olarak incelendi. Bulgular: PrP ile başvuran olguların pubarş başlangıç yaşı ortalama 6,72 ± 0,98 olarak saptandı. PrP ile başvuranların başvuru anı tanı dağılımı %37 izole prematür adrenarş (PA), %32,2'si idiyopatik prematür pubarş (İPP), %29,7'si puberte prekoks (PP), %1,1'i KAH iken; izlem sonu tanı dağılımı %44,8 izole PA, %27,4 PP, %21,9 İPP, %4,8 yavaş seyirli erken puberte, %1,1 NKKAH olarak tespit edildi. Hirsutizm ile başvuran olguların başvuru yaşı ortalama 14,44 ± 2,27 olarak tespit edildi. Hirsutizm ile başvuran olguların tanı dağılımı %44,7 polikistik over sendromu (PKOS), %42,7 idiyopatik hirsutizm (İH), %8 PKOS için riskli ve %4,7 diğer nedenler (2'si idiyopatik hiperandrojenemi, 1'i hiperprolaktinemi, 1'i prolaktinoma, 1'i NKKAH, 1'i malignite, 1'i hipotiroidi) olarak saptandı. PrP ile başvuran 270 olgunun 15'inde izlemde hirsutizm gelişmiş olup bunların tanı dağılımları, 10 olgu (%66,7) İH, 4 olgu (%26,7) PKOS ve 1 olgu (%6,6) PKOS için riskli şeklindeydi. Sonuç: Puberte, bireyler arasında farklı tempoda gelişebilen karmaşık bir süreçtir. PrP ile başvuran olguların başvuru ve izlemde tanı dağılımının farklı olması PrP etiyolojisini ortaya koymak için belli bir süreç gerektiğini düşündürmektedir. Hirsutizm, peripubertal dönemde fizyolojik hiperandrojenemiye bağlı gelişebileceği gibi patolojik durumlara sekonder olarak da ortaya çıkabilir. Bu yüzden hirsutizmin ayırıcı tanısını her olgu özelinde klinik izlem ve verilerle ortaya koymak önemlidir. Anahtar Kelimeler: Prematür pubarş, Prematür adrenarş, Hirsutizm
ABSTRACT Objective: Premature pubarche and hirsutism are two clinical conditions with a high prevalence in the community. In this study, we aimed to reveal the diagnostic distribution of female patients admitted to the Pediatric Endocrinology Clinic with premature pubarche (PrP) or hirsutism by examining all anamnesis and clinical course information, anthropometric measurements, examination findings, hormonal values, and imaging results from the first to the last admission. Materials and Methods: The data of a total of 405 girls (270 with PrP and 135 with hirsutism) admitted to Ondokuz Mayıs University Pediatric Endocrinology Outpatient Clinic between January 1, 2017 and December 31, 2022 were retrospectively examined from the hospital records. Results: The mean age at onset of pubarche was found to be 6.72 ± 0.98 years in patients presenting with PrP. The distribution of diagnosis at the time of presentation was 37% isolated premature adrenarche (PA), 32,2% idiopathic premature pubarche (IPP), 29.7% precocious puberty (PP), 1.1% NCCAH, while the distribution of diagnosis at the end of follow-up was 44.8% isolated PA, 27.4% PP, 21.9% IPP, 4.8% precocious puberty with slow course, 1.1% NCCAH. The mean age at presentation of the patients with hirsutism was 14.44 ± 2.27 years. The diagnostic distribution of the cases presenting with hirsutism was 44.7% polycystic ovary syndrome (PCOS), 42.7% idiopathic hirsutism (IH), 8% at risk for PCOS and 4.7% other causes (2 cases idiopathic hyperandrogenemia, 1 hyperprolactinemia, 1 prolactinoma, 1 NCCAH, 1 malignancy, 1 hypothyroidism). Of the 270 patients who presented with PrP, 15 developed hirsutism during follow-up, and their diagnoses were as follows: 10 cases (66.7%) with IH, 4 cases (26.7%) with PCOS, and 1 case (6.6%) at risk for PCOS. Conclusion: Puberty is a complex process that develops according to the pace of each individual. The fact that the distribution of diagnoses at presentation and follow-up is different in cases presenting with PrP suggests that a certain process is required to reveal the etiology of PrP. Hirsutism may develop due to physiologic hyperandrogenemia in the peripubertal period or secondary to pathologic conditions. Therefore, it is important to establish a differential diagnosis of hirsutism through clinical follow-up and data in each case. Keywords: Premature pubarche, Premature adrenarche, Hirsutism
ABSTRACT Objective: Premature pubarche and hirsutism are two clinical conditions with a high prevalence in the community. In this study, we aimed to reveal the diagnostic distribution of female patients admitted to the Pediatric Endocrinology Clinic with premature pubarche (PrP) or hirsutism by examining all anamnesis and clinical course information, anthropometric measurements, examination findings, hormonal values, and imaging results from the first to the last admission. Materials and Methods: The data of a total of 405 girls (270 with PrP and 135 with hirsutism) admitted to Ondokuz Mayıs University Pediatric Endocrinology Outpatient Clinic between January 1, 2017 and December 31, 2022 were retrospectively examined from the hospital records. Results: The mean age at onset of pubarche was found to be 6.72 ± 0.98 years in patients presenting with PrP. The distribution of diagnosis at the time of presentation was 37% isolated premature adrenarche (PA), 32,2% idiopathic premature pubarche (IPP), 29.7% precocious puberty (PP), 1.1% NCCAH, while the distribution of diagnosis at the end of follow-up was 44.8% isolated PA, 27.4% PP, 21.9% IPP, 4.8% precocious puberty with slow course, 1.1% NCCAH. The mean age at presentation of the patients with hirsutism was 14.44 ± 2.27 years. The diagnostic distribution of the cases presenting with hirsutism was 44.7% polycystic ovary syndrome (PCOS), 42.7% idiopathic hirsutism (IH), 8% at risk for PCOS and 4.7% other causes (2 cases idiopathic hyperandrogenemia, 1 hyperprolactinemia, 1 prolactinoma, 1 NCCAH, 1 malignancy, 1 hypothyroidism). Of the 270 patients who presented with PrP, 15 developed hirsutism during follow-up, and their diagnoses were as follows: 10 cases (66.7%) with IH, 4 cases (26.7%) with PCOS, and 1 case (6.6%) at risk for PCOS. Conclusion: Puberty is a complex process that develops according to the pace of each individual. The fact that the distribution of diagnoses at presentation and follow-up is different in cases presenting with PrP suggests that a certain process is required to reveal the etiology of PrP. Hirsutism may develop due to physiologic hyperandrogenemia in the peripubertal period or secondary to pathologic conditions. Therefore, it is important to establish a differential diagnosis of hirsutism through clinical follow-up and data in each case. Keywords: Premature pubarche, Premature adrenarche, Hirsutism
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