Precocious Puberty in Internationally Adopted Girls

peer reviewedIn internationally adopted girls a high frequency of precocious puberty has been reported in series of patients, and a low age at menarche has been reported from retrospective cohort studies. Data estimating the risk of precocious pubertal development suggests a highly increased risk in internationally adopted girls, possibly related to country of origin and age at adoption. Genetic factors, intrauterine growth retardation, nutritional status prior to adoption, pre- and post adoption growth patterns as well as environmental exposures and psychological stress has been hypothensized to trigger early puberty. However, the mechanism behind precocious and early puberty in adopted girls is still unknown, and central as well peripherally mediated puberty has been suggest. In daily clinical practice, the challenge is therefore to establish guidelines that ensure appropriate recognition of those adopted children who need medical examinations for precocious puberty and to identify the subgroup of patients who will benefit from treatment with GnRH analogs. Prospective, longitudinal studies on growth and development in internationally and domestic adopted children are neaded to disentangle these questions and to understand the pathophysiology