Accelerated pubertal development in patients with shunted hydrocephalus

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ObjectiveTo evaluate pubertal development and peripheral concentrations of gonadotrophins and sex hormones in children with shunted hydrocephalus compared with healthy controls.Study design114 patients (52 females, 62 males) and 73 healthy controls (35 females, 38 males) aged 5 to 20 years were analysed for stage of puberty, age at menarche, testicular volume, basal serum follicle stimulating hormone (FSH), luteinising hormone (LH), sex hormone binding globulin (SHBG), testosterone and oestradiol concentrations, and free androgen index.ResultsMale gonadal and male and female pubic hair development occurred significantly earlier in the patients than in the controls. The mean age at menarche was significantly lower in the female patients than in their controls (11.7 v 13.2 years; p less than 0.001), and lower than it had been for their mothers (v 13.1 years; p less than 0.001). Relative testicular volume was higher in the male patients than in their controls (1.2 standard deviation score (SDS) v 0.2 SDS; p less than 0.001). The prepubertal patients had higher basal LH (0.13 U/l v 0.08 U/l; p less than 0.001) and SHBG (132.3 nmol/l v 109.1 nmol/l; p less than 0.01) than the controls. Both the prepubertal and pubertal females had significantly higher basal FSH than their controls (1.57 U/l v 1.03 U/l; p less than 0.05, and 4.0 U/l v 2.9 U/l; p less than 0.01, respectively).ConclusionsHydrocephalic children experience accelerated pubertal maturation, reflected in a younger age at menarche in females and an increased testicular volume in males. This may be because of enhanced gonadotrophin secretion, possibly resulting from unphysiological variations in intracranial pressure.(Arch Dis Child 1996;74:490-496)

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