Endocrine Disruptors and Precocious Puberty: A Multicenter Analysis of Environmental Exposure and Hormonal Patterns in Pre-Adolescents

Abstract

Background:
There is growing concern about the role of environmental endocrine-disrupting chemicals (EDCs) in altering pubertal timing, particularly the rise in idiopathic central precocious puberty (CPP) in recent decades. This study aimed to investigate the association between early-life exposure to common EDCs and hormonal patterns in pre-adolescent children.

Methods:
A multicenter, observational study was conducted involving 384 children (ages 6–10) presenting with early signs of puberty. Urinary concentrations of bisphenol A (BPA), phthalates, and triclosan were measured using mass spectrometry. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol/testosterone, and dehydroepiandrosterone sulfate (DHEA-S) were analyzed. Bone age advancement was assessed via radiography, and Tanner staging was recorded. Multivariate logistic regression was used to assess the relationship between EDC levels and confirmed CPP diagnosis.

Results:
Elevated urinary BPA (>4.5 µg/g creatinine) was associated with a 3.2-fold increase in odds of CPP diagnosis (95% CI: 2.1–4.8, p < 0.001). Higher phthalate exposure correlated with advanced bone age and elevated LH/FSH ratio (p < 0.01). Children with top-quartile exposure to two or more EDCs showed a statistically significant acceleration in pubertal onset compared to their peers, independent of BMI and genetics.

Conclusion:
Early and cumulative exposure to endocrine-disrupting chemicals is significantly associated with the development of precocious puberty. These findings highlight the urgent need for public health policies limiting EDC exposure and reinforce the importance of environmental surveillance in pediatric endocrinology.