The Assesment of Pubertal Timing in Pediatric Patients Diagnosed With Coeliac Disease
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Keywords:Celiac Disease, Middle Upper Arm Circumference (MUAC), Pediatrics, Puberty, Tanner Staging
Aim: Puberty disorders are observed in Celiac Disease (CD). In our study, we aimed to evaluate pubertal developmental stages, laboratory parameters according to pubertal staging, and anthropometric measurements in children and adolescents with CD.
Material-Method: The study was designed as cross-sectional and included patients with CD, aged 7-16 years, who applied to Adana City Training and Research Hospital Pediatric Gastroenterology 1 Outpatient clinic between 01.10.2022 and 31.12.2022. Tanner stages and hormonal parameters of the cases were recorded.
Results: Of the 108 patients included in the study, 39 (36.1%) were male and 69 (63.9%) were female. While 52 of the cases (48.1%) were Tanner stage 1, 15 (13.9%) were Tanner stage 2, 11 (10.2%) were Tanner stage 3, 7 (6.5%) were Tanner stage 4 and 23 (21.3%) were in Tanner stage 5. The mean age of the cases was 10.7±3.5 years, and the mean follow-up period was 3.7±2.5 years. When the sexes are separated, while the median height is 10.5 percentile (p) (0.01-94.1) for boys, the weight is 8.5 p (0.01-98.8), while the median height is 21.7 p (0.01-96.2) and the weight is 13.6 p (0.01-99.9) for girls. When the patient groups were classified as prepubertal and pubertal according to pubertal stages, 51.9% (n= 56) of the patients were in the pubertal stage and 48.1% (n: 52) were in the prepubertal stage. Vitamin B12, folate, and ferritin levels were found to be lower in pubertal cases than in prepubertal cases (p=0.034, p<0.001, p=0.039, respectively). According to the evaluation, the sensitivity of the middle upper arm circumference (MUAC) cut-off point of 19.8 cm and above in estimating the pubertal stage was found to be 86.5% and the specificity as 78.6% (p<0.001). Mean age at menarche in menstruating patients was within the normal range with 12 ±1.09 years.
Conclusion: Although CD is at risk for delayed puberty, no delay in pubertal findings or gonadal insufficiency was found in our study. It has been shown that MUAC, which is important in terms of malnutrition screening, will also be important in predicting the onset of puberty. In addition, we recommend that close monitoring of blood levels is required in these patients due to the increase in vitamin needs especially in pubertal period.
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