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01.12.2016 | Research | Ausgabe 1/2016 Open Access

International Journal of Pediatric Endocrinology 1/2016

Increasing incidence of premature thelarche in the Central Region of Denmark - Challenges in differentiating girls less than 7 years of age with premature thelarche from girls with precocious puberty in real-life practice

International Journal of Pediatric Endocrinology > Ausgabe 1/2016
Mia Elbek Sømod, Esben Thyssen Vestergaard, Kurt Kristensen, Niels Holtum Birkebæk
Wichtige Hinweise

Competing interests

The authors have no competing interests to declare.

Authors’ contributions

MES: literature research, wrote protocol, data collection, chart reviews, constructed database, data analysis and interpretation, wrote manuscript, created tables and figures. ETV: conceptualized study, study design, wrote protocol, designed and constructed database, collected data, interpreted results, edited and revised manuscript, literature research, approved the final manuscript. KK: conceptualized study, collected data, interpreted results, revised manuscript. NBV: conceptualized study, wrote protocol, collected data, interpreted results, edited and revised manuscript. All authors read and approved the final manuscript.



Premature thelarche (PT) seems to be increasing and it is difficult to differentiate its early stages from precocious puberty (PP). Clinical and biochemical parameters are warranted to differentiate the two diagnoses.


One hundred ninety-one girls aged 0.5–7 years were included. Diagnoses were validated and the girls were categorized to the groups PP (n = 27) and PT (n = 164). Anthropometry, Tanner stages, ethnicity, bone age, and biochemistry, were recorded. Conventional variables for diagnosing PP were compared between the groups at time of referral to identify parameters predictive for the diagnosis.


The referral rate of PT increased from 1998–2013. Girls with PT and PP differed with regards to age at referral, body mass index standard deviation scores (BMISDS), ethnicity, bone age advancement, basal luteinizing hormone (LH), gonadotropin releasing hormone (GnRH) stimulated LH and follicle stimulating hormone (FSH), basal and stimulated LH/FSH ratio, and sex-hormone binding globulin (SHBG). Apart from SHBG there was considerable overlap of the variables between the PT and the PP groups.


First, the incidence of PT appears to increase. Second, SHBG was the variable which best discriminated PT from PP. Third, stimulated LH in 1–3 years old girls with PT is similar to stimulated LH in 5–7 years old girls with PP. Age, BMISDS, ethnicity, bone age, stimulated gonadotropins and LH/FSH and SHBG are all useful variables for differentiating PP from PT. However normative data for stimulated LH and FSH in the age group 0.5–7 years are warranted.
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