# Central precocious puberty in Türkiye, 2018–2024: national incidence, prevalence, and changes across the COVID-19 period

## TL;DR

This study tracks the rise in treated central precocious puberty cases in Türkiye from 2018 to 2024, noting a significant increase during the COVID-19 period.

## Contribution

Provides the first national population-based analysis of CPP incidence and prevalence in Türkiye, including temporal trends during the pandemic.

## Key findings

- National incidence of CPP increased from 25 to 54 per 100,000 between 2018 and 2024.
- Annual case counts peaked during the COVID-19 period and remained elevated afterward.
- 95.6% of CPP cases identified were in girls.

## Abstract

Rates of central precocious puberty (CPP) are increasing worldwide; however, contemporary population-based studies remain limited in many settings, including Türkiye, and temporal patterns across the COVID-19 period are incompletely characterised. To address these gaps we aimed to quantify national incidence and prevalence of treated CPP from 2018 to 2024 and to describe temporal patterns across the COVID-19 period and geographic variation.

We conducted a retrospective, population-based registry study using Türkiye’s national electronic health record system (e-Nabız). For incidence analyses, we included girls aged <10 years and boys aged <11 years between Jan.1,2018, and Dec.31,2024; prevalence analyses included girls aged ≤11 years and boys aged ≤12 years to capture ongoing treatment. CPP cases were identified using a combined diagnostic and treatment algorithm requiring pediatric endocrinology evaluation, CPP-related ICD-10 coding at point of care, and sustained GnRHa treatment (≥3 prescriptions issued on separate dates, with a minimum interval of 15 days). Annual incidence and prevalence were calculated using Turkish Statistical Institute denominators and stratified by sex, year, and region.

We identified 41–169 treated CPP cases, 95.6% in girls (39380/41169). National incidence increased from 25 to 54 per 100,000 between 2018 and 2024, and prevalence from 23 to 112 per 100 000. Annual case counts peaked following the COVID-19 period (3816 in 2019 to 7653 in 2021) and subsequently plateaued above pre-pandemic levels.

In this national, population-based study from Türkiye, the incidence of treatment-initiated CPP increased substantially between 2018 and 2024, with a pronounced rise during the COVID-19 period and persistently higher levels thereafter. These findings are relevant for pediatric endocrine service planning and population-level public health strategies, but should be interpreted as temporal trends in specialist-confirmed, treatment-requiring CPP rather than the full clinical spectrum of CPP (including the pandemic period) or a direct measure of biological pubertal onset in the general population.