ESPE Yearbook of Paediatric Endocrinology

Brief summary: This study investigated the evolution of precocious puberty incidence in Korea between 2016 and 2021. A rapid increase was observed from April 2020, which the authors link to the restrictions due to the COVID-19 pandemic.

The onset of secondary sex characteristics has shown a secular trend towards earlier ages for many decades (1). This has been attributed to socioeconomic and environmental changes. Like many other countries, a steady increase in the incidence of precocious puberty has been well described in Korea and other countries (2-4).

In this study, the numbers of patients diagnosed with precocious puberty in medical facilities in Korea between 2016 and 2021 was analyzed using the Healthcare Big Data Hub, as well as the status of insurance treatment costs. Two new trends were discovered. First, the incidence of precocious puberty increased much more rapidly between 2020 and 2021 (1.2-fold increase between January 2016 and March 2020, versus 1.68-fold increase between January 2016 and March 2021). The monthly analysis pinpoints to a rapid increase specifically from April 2020 until June 2021. This period corresponds to the start of the COVID-19 pandemic. The authors suggest several causes for this phenomenon. The increase in BMI linked to a sedentary lifestyle and the high-calorie food consumption could play a key role in this trend. Excessive use of electronic devices could also interfere with melatonin production, which in turn can affect the hypothalamic-pituitary-gonadal axis (5). Finally, other factors such as exposure to endocrine disruptors, anxiety, change in sleep patterns and direct stimulation of the central nervous system due to a COVID-19 infection are also cited as potential causes.

The second trend detected here is the increasing proportion of males diagnosed with precocious puberty. This is attributed to greater parental awareness in addition to environmental factors. Indeed, the increase in the proportion of male patients diagnosed before 9 years of age and the increase in the total number of male patients occurred simultaneously, which means, the prevalence rate increased as a result of the growing awareness of precocious puberty in males. In addition, the sudden increase in male patients coincided with the period of COVID-19, likely due to restriction of physical activity and increased BMI in previously active males.

In conclusion, this large study shows a rapid increase in the number of Korean patients diagnosed with precocious puberty since April 2020, as a potential consequence of the COVID-19 pandemic, in accordance with other smaller studies (6–8). Further investigations are required to determine the possible causes of this increasing prevalence of precocious puberty and to monitor whether the rapid rise will reverse.

References: 1. Eckert-Lind C, Busch AS, Petersen JH, Biro FM, Butler G, Brauner EV, Juul A. Worldwide secular trends in age at pubertal onset assessed by breast development among females: a systematic review and meta-analysis. JAMA Pediatr. 2020;174:e195881. 2. Choi KH, Park SC. An increase of patients diagnosed as precocious puberty among Korean children from 2010 to 2015. J Pediatr Korean Med. 2016;30:60–5. 3. Kim SH, Huh K, Won SH, Lee KW, Park MJ. A significant increase in the incidence of central precocious puberty among Korean females from 2004 to 2010. PLoS One. 2015;10:e141844. 4. Bräuner EV, Busch AS, Eckert-Lind C, Koch T, Hickey M, Juul A. Trends in the incidence of central precocious puberty and normal variant puberty among children in Denmark, 1998 to 2017. JAMA Netw. Open. 2020;3(10):e2015665. 5. De Holanda FS, Tufik S, Bignotto M, Maganhin CG, Vieira LHL, Baracat EC, Soares JM Jr. Evaluation of melatonin on the precocious puberty: a pilot study. Gynecol. Endocrinol. 2011;27:519–23. 6. Baehr S, Schnabel D, Woelfle J, Schreiner F, Gohlke B. National survey of referrals for precocious puberty in Germany. BMJ Paediatr. Open. 2023;7(1):e001987. 7. Baby M, Ilkowitz J, Cheema Brar P. Impacts of the COVID-19 pandemic on the diagnosis of idiopathic central precocious puberty in pediatric females in New York City. J Pediatr Endocrinol Metab. 2023;36(6):517–522. 8. Chioma L, Chiarito M, Bottaro G, Paone L, Todisco T, Bizzarri C, Cappa M. COVID-19 pandemic phases and female precocious puberty: The experience of the past 4 years (2019 through 2022) in an Italian tertiary center. Front. Endocrinol. (Lausanne). 2023;14:1132769.