ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Journal of Clinical Endocrinology and Metabolism vol. 105,8 (2020): dgaa135. doi: https://academic.oup.com/jcem/article/105/8/dgaa135/5807960

This meta-analysis of 22 studies, comprising in total 21 801 individuals, evaluates the accuracy of self-assessment of pubertal stage by the patient him/herself, given the many challenges in obtaining clinician-assessed Tanner Staging.

Clinicians, researchers and health advocates know how challenging it can be to accurately evaluate pubertal stage in some adolescent patients. Nevertheless, monitoring of pubertal development is an important part of disease management, and even health monitoring given the fact that age at puberty is associated with many later-life health outcomes (1–3).

Previous studies have highlighted the wide interest in self-report measures of pubertal status (4–6), but this is the first systematic review, using formal meta-analysis methods and encompassing a large number of participants (including male patients). The findings provide reliable information on self-assessment of pubertal stage:

– Self-assessment is reliable to identify Tanner stages 1 and 5, or to categorize pubertal development into the three categories: pre-puberty; in or early puberty; and completing or late puberty. However, it is less accurate to identify Tanner stages 2, 3 and 4, for which expert clinician assessment remains paramount. Girls seem to better assess pubertal stages than boys.– The use of some self-assessment tools, such as images and test descriptions, increases the agreement with clinician assessments.– Overweight and obesity do not seem to weaken the reliability of self-assessment.

The authors described limitations in the published evidence, such as variable levels of examiner’s confidence in pubertal examination, included studies were mostly from high-income countries with Caucasian youth, and no patients were included with incongruence or with delayed or precocious puberty. However, this study highlights the importance of being aware of these nuances when interpreting self-assessed pubertal development, for example in remote clinics during the COVID-19 pandemic.

References:

1. Zhu J, Chan YM. (2017). Adult Consequences of Self-Limited Delayed Puberty. Pediatrics. 139(6):e20163177.

2. Day FR, Elks CE, Murray A, Ong KK, Perry JR. (2015). Puberty timing associated with diabetes, cardiovascular disease and also diverse health outcomes in men and women: the UK Biobank study. Sci Rep. 5:11208.

3. Elhakeem A, Frysz M, Tilling K, Tobias JH, Lawlor DA. (2019). Association Between Age at Puberty and Bone Accrual From 10 to 25 Years of Age. JAMA Netw Open. 2(8):e198918.

4. Chavarro JE, Watkins DJ, Afeiche MC, et al. (2017). Validity of Self-Assessed Sexual Maturation Against Physician Assessments and Hormone Levels. J Pediatr. 186:172–178.e3.

5. Petersen AC, Crockett L, Richards M, Boxer A. (1988). A self-report measure of pubertal status: Reliability, validity, and initial norms. J Youth Adolesc. 17(2):117–133.

6. Rasmussen AR, Wohlfahrt-Veje C, Tefre de Renzy-Martin K, et al. (2015). Validity of self-assessment of pubertal maturation. Pediatrics. 135(1):86–93.