Clinical spectrum of precocious puberty and its normal variants in children: insights from a seven-year review in a tertiary hospital, Calabar, Nigeria

Abstract

Context: Precocious puberty, clinically defined as the development of secondary sexual characteristics before 8 years of age in girls and 9 years in boys, represents a clinical spectrum that encompasses both pathological and non-pathological variants of early pubertal onset. Given the paucity of data from African settings, there is a compelling need to characterize the local spectrum of precocious puberty and its normal variants.

Objective: To describe clinical patterns, demographics, aetiologies, diagnostic patterns, management, and outcomes of children presenting with precocious puberty (PP) and its normal variants at University of Calabar Teaching Hospital, Nigeria, over seven years.

Materials and Methods: This was a retrospective descriptive study carried out between January 2015 and December 2021 involving children aged 0-18 years who presented with signs of early pubertal development. Data collected included demographics, clinical presentation, diagnosis (CPP, PPP, normal variants), skeletal age (Greulich–Pyle), Tanner staging, radiology, and biochemistry. GnRH analogues were used for children confirmed to have idiopathic central precocious puberty, specific treatments were given to children for the cause of peripheral precocious puberty when identified and parents were reassured for patients identified with the normal variants. Descriptive statistics used to analyse data.

Results: 24 patients (12.3% of endocrine cases) had precocious puberty with a M: F ratio of 1:2.3 and median age of 5.5 years. CPP was diagnosed in 8 (33%) patients, all female and idiopathic precocious puberty including PPP: 4 (17%) with causes—virilizing adrenal tumour (1), CAH (1), McCune-Albright (1), exogenous hormone (1). Normal variants were seen in 12 (50%) children presenting as premature thelarche/adrenarche. Approximately 91.6% were from middle socioeconomic class. Most cases of normal variants required only monitoring, whereas true precocious puberty cases were managed with endocrine evaluation and treatment as indicated.

Conclusion: Benign variants and female predominance were noted among children presenting with precocious puberty. CPP was most common true form of precocious puberty. Awareness and accurate diagnosis are essential for targeted management. Regional data as presented in this study will enhance understanding of epidemiology of PP in sub-Saharan-Africa.