Puberty and resultant increased bone turnover as a possible etiology of an increased lead concentration in a pre-adolescent girl

Abstract

Introduction: We present a case in which puberty likely resulted in an increased lead concentration in a pre-adolescent girl.

Case report: A 12-year-old girl was referred to the pediatric environmental health clinic (PEHC) after her blood lead level (BLL) was found to be elevated to 30 µg/dL (reference <5 µg/dL). She had been seen in the PEHC 6 years previously for management of a BLL as high as 36 µg/dL. Fifteen months prior to her repeat PEHC referral, her BLL had been 10 µg/dL. In those intervening 15 months, she grew 10.42 cm. Thyroid studies were normal. Four months after re-referral, her osteocalcin concentration, a marker of bone turnover, was 212 ng/mL (normal 9–42 ng/mL in adults >18 years); 10.5 months after the peak BLL of 32 mcg/dL, her BLL was 16 µg/dL, osteocalcin was 69 ng/mL, and her rate of growth had declined to 0.20 cm/30 days (peak: 1.07 cm/30 days). No external source of her exposure was found.

Discussion: Osteocalcin concentrations and plotting the changes in growth velocity over time may assist clinicians in determining if pubertal growth is playing a role in unexpectedly increased BLL discovered in adolescents for whom no external source of lead exposure can be found.

Keywords:

• Lead poisoning
• puberty
• osteocalcin

Acknowledgments

The authors would like to recognize Lorraine Simbliaris and Andrew J. Turner, PhD for their assistance with this case report.

Disclosure statement

No potential conflict of interest was reported by the authors.