IMPE Abstracts

Introduction: Puberty is a biological maturation process that involves genetic, metabolic, environmental, ethnic, geographic, and economic factors. During the coronavirus 2019 (COVID-19) pandemic, an increase in referrals for central precocious puberty (CPP) assessment was observed in clinical practice.

Methods: We evaluated the incidence of CPP before and during the COVID-19 pandemic in different countries. A PRISMA-compliant systematic review was performed in the MEDLINE and Embase databases, with “precocious puberty" and “COVID-19” as search terms. Exclusion criteria were an identifiable organic cause for CPP, genetic disorders or peripheral precocious puberty. The study was registered in PROSPERO with accession number CRD42022359281.

Results: Fifteen studies comprising 168947 participants from 7 countries (Italy, Turkey, Spain, China, India, Brazil and South Korea) were included. Eight studies included only girls in the analysis. Fourteen studies found a 1.5- to 4.4-fold increase in the incidence of CPP in girls during the pandemic. In boys, 2 studies found a 3- to 3.4-fold increase in CPP, 3 studies found no significant difference in the number of cases and 1 study detected a 75% decrease in the diagnosis. Some authors reported an increase in the use of electronic devices, more sedentary lifestyle, higher gonadotropins and estradiol levels, more advanced bone age and Tanner stage, higher Z-scores for weight and lower age at pubertal onset during COVID-19 pandemic years. On the other hand, a lower BMI and a higher frequency of Tanner 2 stage during pandemic were also described.

Conclusions: There has been an increase in the incidence of precocious puberty during the COVID-19 pandemic among girls. This finding was not consistently detected among boys. Possible causes include increased screen time, reduced physical activity, psychological stress, changes in diet and sleep habits, and SARS-COV2 direct effects.