6783 Review of precocious puberty referrals to paediatric endocrinology services in the west of ireland: a retrospective study

Objectives Over the last decade, there has been a trend towards an earlier onset of puberty which prompted an increase in referrals to Paediatric Endocrinology services due to concerns around precocious puberty.¹ Precocious puberty is defined as the onset of secondary sexual characteristics before the age of 8 for girls and before 9 years of age for boys.² Features of central precocious puberty need to be differentiated from benign variants such as premature thelarche and premature adrenarche in order to triage patients appropriately.³ Given the increase in precocious puberty referrals, we looked to assess the content of the referral letters to highlight areas of knowledge deficit and provide a focus area for improvement with the aim of better allocating our resources in the management of true precocious puberty. Methods We conducted a retrospective study at University Hospital Galway. Files of patients who attended the Paediatric Endocrinology clinic in 2022 were reviewed. Precocious puberty referrals were identified using our secure patient information portal, EVOLVE. Referral letters were reviewed, and data were collated anonymously and analysed using SPSS. Descriptive statistics were used to summarise data. Results Thirty-eight referrals; 68% (n=26/38) were general practitioner referrals; 86.8% of patients (n=33/38) were females. The mean (SD) age at the time of referral was 7 years (± 1.62). The majority of referrals, 86.6% (33/38), mentioned pubic hair development, but only 57.7% (19/33) commented on breast development. Additionally, only 15.1% (5/33) and 23.7% (9/38) of referrals included the breast/pubic hair tanner stage, and centiles/growth spurts were not included in 65.7% (25/38). Of the 36 patients who attended the clinic, 52% were diagnosed with premature adrenarche and 30.6% with central precocious puberty. Conclusion The results of our study highlight the need for the provision of education for practitioners referring patients with suspected precocious puberty and the need for a standardized referral proforma. References 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 network Open 2020 Oct 1;3(10):e2015665. Kaplowitz P, Bloch C, Sills IN, Bloch CA, Casella SJ, Gonzalez JL, Lynch JL, Wintergerst KA. Evaluation and referral of children with signs of early puberty. Pediatrics 2016 Jan 1;137(1). Prosperi S, Chiarelli F. Early and precocious puberty during the COVID-19 pandemic. Frontiers in Endocrinology 2023 Jan 9;13:1107911.