Early puberty in internationally adopted girls: hormonal and clinical markers of puberty in 276 girls examined biannually over two years.
OBJECTIVE
Retrospective studies have indicated that internationally adopted girls are at high risk of developing precocious puberty. Hypothetically, this could be due to selection bias. The aim of this study was to determine age at reaching pubertal milestones in healthy internationally adopted girls in a prospective, clinical study.


METHODS
A longitudinal cohort study including 276 randomly recruited internationally adopted girls. At baseline, age ranged from 4 to 13 years. Participants were followed with biannual examinations over a period of 2 years. Examinations included height, weight, Tanner staging, blood sampling and bone age assessment. Age distribution at entering pubertal stages B2-B5 (breast development), PH1-PH5 (pubic hair development) and menarche was estimated by probit analysis. Data were compared to a reference population of Danish-born girls, studied cross-sectionally.


RESULTS
Mean age at B2+ was 9.5 years (95% prediction interval 7.1-12.0 years) and mean age at menarche was 12.1 (10.2-14.0) years in adopted girls, which was significantly lower compared to the reference group (p < 0.0003). 16% of adopted girls entered stage B2 before 8 years of age. The puberty-related rise in LH, FSH and estradiol was detected at earlier ages in adopted girls compared to the reference group.


CONCLUSIONS
Internationally adopted girls have a significantly higher risk of precocious pubertal maturation compared to Danish-born girls.
Department of Growth and Reproduction GR-5064, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. gteilmann@hotmail.dk
Grete
G
Teilmann
Jørgen H
JH
Petersen
Magdalena
M
Gormsen
Karen
K
Damgaard
Niels E
NE
Skakkebaek
Tina Kold
TK
Jensen
D000293:Adolescent; D000300:Adoption; D000365:Age Determination by Skeleton; D000375:Aging; D001724:Birth Weight; D015992:Body Mass Index; D001940:Breast / Q000254:growth & development; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003718:Denmark / Q000453:epidemiology; D054242:Emigrants and Immigrants; D004958:Estradiol / Q000097:blood; D005260:Female; D006065:Gonadotropins, Pituitary / Q000097:blood; D006801:Humans; D007265:Inhibins / Q000097:blood; D008137:Longitudinal Studies; D008572:Menarche; D011629:Puberty, Precocious / Q000453:epidemiology*; D012738:Sex Hormone-Binding Globulin / Q000032:analysis; D012959:Socioeconomic Factors
D006065:Gonadotropins, Pituitary; D012738:Sex Hormone-Binding Globulin; D004958:Estradiol; D007265:Inhibins