Study on TCM Syndrome Distribution Characteristics and Hypothalamic-Pituitary-Gonadal Axis-Related Indicators in Girls with Central Precocious Puberty

Abstract

Objective: To explore the distribution characteristics of Traditional Chinese Medicine (TCM) syndromes in girls with central precocious puberty (CPP) and their correlations with indicators related to the hypothalamic-pituitary-gonadal (HPG) axis. Methods: A cross-sectional observational study design was adopted. A total of 122 girls diagnosed with CPP who visited the Department of Pediatric Endocrinology, the Second Affiliated Hospital of Shaanxi University of Chinese Medicine between March 2024 and September 2025 were enrolled. Western medicine diagnosis was implemented in accordance with the Expert Consensus on the Diagnosis and Treatment of Central Precocious Puberty (2022). TCM syndrome differentiation was conducted based on the Clinical Diagnostic and Therapeutic Guidelines of Pediatric TCM: Precocious Puberty combined with clinical expert experience. All patients were categorized into three syndrome types: yin deficiency with effulgent fire, liver depression transforming into fire, and internal accumulation of phlegm-heat. We analyzed the distribution of TCM syndromes and their associations with age at onset, disease course, Tanner breast staging, body mass index (BMI), uterine and ovarian development, and basal sex hormone levels. Results: (1) Among the 122 girls with CPP, 59 cases (48.36%) presented yin deficiency with effulgent fire, 40 cases (32.79%) internal accumulation of phlegm-heat, and 23 cases (18.85%) liver depression transforming into fire. Yin deficiency with effulgent fire was the predominant syndrome type. (2) Statistically significant intergroup differences were observed across syndrome types in age at onset, disease course, BMI stratification, Tanner breast staging, and partial HPG axis-related indicators. Girls with internal accumulation of phlegm-heat had a higher proportion of overweight and obesity as well as relatively longer disease courses; those with yin deficiency with effulgent fire exhibited a younger average age at onset. Basal luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels differed significantly among the three syndrome groups, indicating a correlation between TCM syndrome differentiation and the activation status of the HPG axis. (3) As disease course prolonged, uterine length, uterine volume, and bilateral ovarian volumes all showed an upward trend. Basal LH, FSH and estradiol (E₂) levels also generally increased, demonstrating that disease progression was closely correlated with HPG axis activation and enhanced development of target reproductive organs. Conclusion: The TCM syndrome distribution among girls with CPP is dominated by yin deficiency with effulgent fire, followed by internal accumulation of phlegm-heat, while liver depression transforming into fire accounts for the smallest proportion. Distinct TCM syndrome types differ in disease course, physical development, sexual maturation severity, and HPG axis-related biomarkers, suggesting that TCM syndrome differentiation can partially reflect the clinical heterogeneity of CPP.