An Investigation of the Association of Tanner Stage and Dehydroepiandrosterone during Pubertal Development Open Access

Abstract

Over time, a significant decrease in age at entry into puberty has been
demonstrated in the United States. Several negative outcomes associated with early entry
into puberty for males and females, include increased risk of testicular cancer in men and
breast cancer in women. Previously, many studies investigating pubertal development
utilized Tanner staging to assess maturation. However, biological hormone markers,
such as Dehydroepiandrosterone (DHEA), may provide a more objective method for
measuring pubertal development. Several studies have indicated a significant rise in
DHEA concentrations during early stages of maturation. In a longitudinal study of 77
children and adolescents, aged 7 to 16, the relationship between Tanner stage and DHEA
was evaluated. Measures of pubertal development, including self-assessed Tanner Stage,
anthropometric measurements, and salivary DHEA concentrations, were taken at three
separate visits over a six-month period. Additionally, parental assessment of Tanner
Stage was performed at each visit for children 7 to 10 years old. Medical conditions,
medication history, and other lifestyle factors were assessed by questionnaire. After
adjusting for age, Tanner stage 2 for female pubic hair development was associated with
a significant increase in DHEA concentration of 2.7 pg/mL (95% CI: 1.3 - 5.6).
Similarly, when adjusting for age, Tanner stage 2 for male pubic hair development was
associated with a significant increase in DHEA concentration of 2.5 pg/mL (95% CI: 1.4
- 4.6). For female pubic hair development, there was overall agreement between self-
assessed Tanner stage and parental Tanner stage for 90% of children with a kappa
statistic for inter-rater agreement of 0.62. For female breast development, there was
overall agreement in 91% of children with a kappa statistic of 0.76. For male pubic hair
development, there was overall agreement in 67% of children with a kappa statistic of
0.37. For male genital development, there was overall agreement 71% of children with a
kappa statistic of 0.10. High levels of inter-rater reliability were found between the child
and parental assessment of female Tanner stages. Additionally, the results of this study
confirm the association between an increase in androgen levels and the development of
pubic hair during the early stages of maturation.

Table of Contents

BACKGROUND .................................................................................................................1

Introduction ..................................................................................................................1

Early Pubertal Development ........................................................................................1

Dehydroepiandrosterone (DHEA) ................................................................................4

Tanner Stages ...............................................................................................................6
METHODS ..........................................................................................................................9
Study Design and Population .......................................................................................9
Questionnaires ............................................................................................................10
Tanner Stage Assessments .........................................................................................10
Anthropometric Measurements ..................................................................................12
Collection of DHEA Samples ....................................................................................12
Laboratory Analysis of DHEA Samples ....................................................................14
Data Analysis Plan .....................................................................................................15
RESULTS ..........................................................................................................................19
DISCUSSION ....................................................................................................................26
REFERENCES ..................................................................................................................32
TABLES ............................................................................................................................39
FIGURES ...........................................................................................................................61
APPENDIX ........................................................................................................................68

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Tanner Stage Puberty DHEA
Committee Chair / Thesis Advisor	Marcus, Michele, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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