The screening questionnaire included information used to determine the following: Tanner stage
of pubertal development using modified diagrams (28); amount of ballet and sport and physical activity they participated in; as well as a brief description of any sport- or dance-related injuries in the 6 weeks prior to data collection.
The data collection for the Puberty Cohort began at 11.5 y of age and ended when the child was fully sexual matured (defined as Tanner stage
5 for pubic hair development and genital/breast development) or turned 18 y of age, whichever came first.
The minimum Tanner stage
of puberty was 2 and median stage was 5 in both groups.
Pre-pubertal stage could be prolonged and pubertal development shifted to a later age in elite gymnasts, maintaining a normal rate of pubertal progression as normal girls require an average about two years for their breast development to progress from Tanner stage
2 to Tanner stage
4 (Daly et al., 1999; Dowthwaite et al., 2012).
It is well documented that retroareolar ovoid hyperechoic tissue was identified similar with nodular gynecomastia only in Tanner stage
Testicular and pubic hair development was in Tanner stage
II (testicular volume 6 ml).
Figure 1 shows the distribution of fasting glucose, fasting insulin, and HOMA-IR according with the Tanner stage
in the study population.
Table 1 shows the distribution of the study population by age, weight, height and BMI, median BMI-SDs and type of school, categorised according to the Tanner stage
Instead, HOMA-IR was inversely related to Tanner stage
([beta] = -0.90 (95% CI -1.40/-0.40); p = 0.001), as well as testicular volume ([beta] = -0.19 (95% CI -0.28/-0.09); p <0.001), and testosterone levels ([beta] = -0.13 (95% CI -0.20/-0.06); p <0.001).
Patients were regarded as being prepubertal if female breast development was Tanner stage
I and if male testes were < 4 mL.
Stage of puberty was assessed by the attending physician, using Tanner stage
, and categorized into prepubertal (T1), pubertal (T2-4), and postpubertal (T5).
Follow-up examination did not reveal an electrolyte disorder; the Tanner stage
and bone age remained stable, and the levels of 17-OH progesterone dropped from 52.00 to 28.00 ng/ dL after 1 year and 3 months of treatment.