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성조숙증에 대한 임상적 고찰

Other Titles
 Clinical studies on sexual precocity 
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[한글] 성조숙증은 원인을 알 수 없는 경우가 많지만 중추 신경계, 성선, 부신등의 질환에 의해 나타날 수 있고 각 원인에 따른 치료가 필요하다. 저자는 1778년 8월부터 1984년 7월까지 연세의료원 소아과에 성조숙을 주소로 내원한 33명의 환아에 대하여 병력조사와 진찰, 방사선 검사, 호르몬 측정, 그리고 LHRH 자극시험을 하여 다음과 같은 결과를 얻었다. 1. 성조숙증의 원인은 가성 성조숙증의 경우 premature thelarche가 8예, premature pubarche가 2예, 부신피질증후군이 3예, 그리고 약물투여에 의한 경우가 2예였다. 진성 성조숙증 중에선 18예중 송과체 기형종이 1예, 갑상선기능저하증이 1예이고 그 이외에서는 원인이 밟혀지지 않았다. 2. 성조숙증을 보인 남아에선 골연령과 신장연령이 진행되었으며 혈중 testosterone 농도가 현저히 증가하였다. 3. 가성 성조숙증 여아에선 골연령이나 신장연령의 진행이 없었고 Tanner stage Ⅱ의 사춘기 단계를 보였으나 질출혈은 없었고 혈중 estradiol, LH, FSH 농도가 대부분 정상이었으며 LHRH 투여뇌하수체의 LH, FSH 반응도는 미약하였다. 4. 진성 성조숙증인 여아들에서의 골연령과 신장연령은 대부분 진행되었으며 사춘기 발달정도는 주로 Tanner stage Ⅱ이며 6예에서 질출혈이 있었다. 혈중 estradiol, LH, FSH 농도가 증가되었으며 LHRH 투여후 뇌하수체의 LH , FSH 반응도가 현저하였다.
[영문] The majority of cases of sexual precocity is idiopathic, but it can be caused by the intracranial lesions, gonadal or adrenal disorders. Clinical studies on the 33 cases of precocious puberty who visited the Dept. of Pediatrics of Yonsei Medical Center from Aug. 1978 to July 1982 were subjected in this study. The careful history taking, physical examination, radiologic and hormonal evaluation, and LHRH test were performed. The results were as follows. 1. The 15 patients were proved as pseudosexual precocity : premature thelarche in 8 cases, premature pubarche in 2, congenital adrenal hyperplasia in 3, and drug induced precocity in 2 cases. Among 18 cases of true sexual precocity, each one case of pineal teratoma and hypothyroidism was discovered, being the remainders idiopathic. 2. In male sexual precocity, the bone age and height age were progressed beyond the chronological age. The pubertal stages were stage Ⅱ or Ⅲ according to Tanner's criteria. The serum concentrations of testosterone were increased to the levels in adults. 3. In female pseudosexual precocity, the bone age and height age were compatible with the chronological age. The breast or public hair developments showed Tanner stage Ⅲ but vaginal bleeding was not noted. The serum levels of estradiol, LH, and FSH were within normal ranges in almost all cases. The in crease in concentrations of serum LH and FSH after synthetic LHRH injection was minimal. 4. In female true sexual precocity, the bone age and height age were advanced in majority of the cases. the pubertal states were Tanner stage Ⅱ or Ⅲ. Vaginal bleeding was noted in 6 cases. The serum concentrations of estradiol, LH and FSH were increased in all, and sharp increase in LH and FSH after LHRH injection was noted.
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