{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:51:21Z","timestamp":1791478281923,"version":"4.3.4"},"reference-count":63,"publisher":"Walter de Gruyter GmbH","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The COVID-19 pandemic was associated with a marked increase in central precocious puberty (CPP), particularly among girls, with pooled estimates showing higher odds during pandemic than pre-pandemic periods. The available evidence supports a reproducible epidemiological signal, but it does not establish a single causal mechanism. This narrative review synthesizes epidemiological findings, clinical features, and proposed mechanisms, including sedentary behavior, weight gain, increased screen exposure, sleep and melatonin rhythm disruption, psychological stress, altered healthcare-seeking behavior, and environmental endocrine-disrupting chemicals (EDCs). Recent high-throughput toxicology data indicate that selected environmental compounds, including musk ambrette and some quaternary ammonium compounds (QACs), can activate human KISS1R- or GnRHR-related signaling in experimental systems. However, pediatric exposure levels, internal dose, target-tissue concentrations, and disease-level causality remain unproven. We therefore frame these chemical findings as a hypothesis-generating exposomic perspective rather than as an established explanation for pandemic-era CPP. A cautious integrative model may help reconcile the strong female predominance, limited mean BMI shift, and temporal association with lockdown-related exposures, while defining testable priorities for future cohort, exposure, and mechanistic studies.<\/jats:p>","DOI":"10.1515\/jpem-2026-0331","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:55:57Z","timestamp":1785214557000},"page":"977-989","source":"Crossref","is-referenced-by-count":0,"title":["Post-COVID-19 rise in central precocious puberty: an integrative Review"],"prefix":"10.1515","volume":"39","author":[{"given":"Xiaoya","family":"Chen","sequence":"first","affiliation":[{"name":"Ningbo Ninth Hospital Medical Health Group , Ningbo , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuxia","family":"Ding","sequence":"additional","affiliation":[{"name":"Women and Children\u2019s Hospital of Ningbo University , Department of Pediatric Endocrinology, Genetics and Metabolism , Ningbo , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"2026100815572197494_j_jpem-2026-0331_ref_001","doi-asserted-by":"crossref","unstructured":"Cheuiche, AV, Teixeira, MG, Moro, C, Guimar\u00e3es, G, Salvador, L, Czepielewski, MA, et al.. Impact of the COVID-19 pandemic on the incidence of central precocious puberty: a PRISMA-ScR-COMPLIANT scoping review. Arch Endocrinol Metab 2025;69:e240300. https:\/\/doi.org\/10.20945\/2359-4292-2024-0300.","DOI":"10.20945\/2359-4292-2024-0300"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_002","doi-asserted-by":"crossref","unstructured":"Zhang, J, Xu, J, Tang, X, Wu, R. Comparison of central precocious puberty frequency before and during COVID-19: a systematic review and meta-analysis. BMC Endocr Disord 2024;24:219. https:\/\/doi.org\/10.1186\/s12902-024-01749-4.","DOI":"10.1186\/s12902-024-01749-4"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_003","doi-asserted-by":"crossref","unstructured":"Herbison, AE. The gonadotropin-releasing hormone pulse generator. Endocrinology 2018;159:3723\u201336. https:\/\/doi.org\/10.1210\/en.2018-00653.","DOI":"10.1210\/en.2018-00653"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_004","doi-asserted-by":"crossref","unstructured":"Pinilla, L, Aguilar, E, Dieguez, C, Millar, RP, Tena-Sempere, M. Kisspeptins and reproduction: physiological roles and regulatory mechanisms. Physiol Rev 2012;92:1235\u2013316. https:\/\/doi.org\/10.1152\/physrev.00037.2010.","DOI":"10.1152\/physrev.00037.2010"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_005","doi-asserted-by":"crossref","unstructured":"Street, ME, Ponzi, D, Renati, R, Petraroli, M, D\u2019Alvano, T, Lattanzi, C, et al.. Precocious puberty under stressful conditions: new understanding and insights from the lessons learnt from international adoptions and the COVID-19 pandemic. Front Endocrinol (Lausanne) 2023;14:1149417. https:\/\/doi.org\/10.3389\/fendo.2023.1149417.","DOI":"10.3389\/fendo.2023.1149417"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_006","doi-asserted-by":"crossref","unstructured":"Abreu, AP, Dauber, A, Macedo, DB, Noel, SD, Brito, VN, Gill, JC, et al.. Central precocious puberty caused by mutations in the imprinted gene MKRN3. N\u00a0Engl J Med 2013;368:2467\u201375. https:\/\/doi.org\/10.1056\/nejmoa1302160.","DOI":"10.1056\/NEJMoa1302160"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_007","doi-asserted-by":"crossref","unstructured":"Dauber, A, Cunha-Silva, M, Macedo, DB, Brito, VN, Abreu, AP, Roberts, SA, et al.. Paternally inherited DLK1 deletion associated with familial central precocious puberty. J\u00a0Clin Endocrinol Metab 2017;102:1557\u201367. https:\/\/doi.org\/10.1210\/jc.2016-3677.","DOI":"10.1210\/jc.2016-3677"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_008","doi-asserted-by":"crossref","unstructured":"Parent, AS, Teilmann, G, Juul, A, Skakkebaek, NE, Toppari, J, Bourguignon, JP. The timing of normal puberty and the age limits of sexual precocity: variations around the world, secular trends, and changes after migration. Endocr Rev 2003;24:668\u201393. https:\/\/doi.org\/10.1210\/er.2002-0019.","DOI":"10.1210\/er.2002-0019"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_009","doi-asserted-by":"crossref","unstructured":"S\u00f8rensen, K, Mouritsen, A, Aksglaede, L, Hagen, CP, Mogensen, SS, Juul, A. Recent secular trends in pubertal timing: implications for evaluation and diagnosis of precocious puberty. Horm Res Paediatr 2012;77:137\u201345. https:\/\/doi.org\/10.1159\/000336325.","DOI":"10.1159\/000336325"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_010","doi-asserted-by":"crossref","unstructured":"Fanaki, M, Michala, L, Nazari, E, Daskalakis, G. Central precocious puberty during the COVID-19 pandemic period: a systematic review of literature. Cureus 2024;16:e71002. https:\/\/doi.org\/10.7759\/cureus.71002.","DOI":"10.7759\/cureus.71002"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_011","doi-asserted-by":"crossref","unstructured":"Prosperi, S, Chiarelli, F. Early and precocious puberty during the COVID-19 pandemic. Front Endocrinol (Lausanne) 2022;13:1107911. https:\/\/doi.org\/10.3389\/fendo.2022.1107911.","DOI":"10.3389\/fendo.2022.1107911"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_012","doi-asserted-by":"crossref","unstructured":"Hoskyns, RB, Howard, SR. Effects of the COVID-19 pandemic on the incidence of central precocious puberty; a narrative review. J\u00a0Pediatr Endocrinol Metab 2024;37:102\u20139. https:\/\/doi.org\/10.1515\/jpem-2023-0507.","DOI":"10.1515\/jpem-2023-0507"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_013","doi-asserted-by":"crossref","unstructured":"Nguyen, NN, Do, TD, Truong, HH, Mai, AN, Chen, YC. Difference in precocious puberty between pre-COVID-19 and COVID-19 periods: a meta-analysis. Am J Epidemiol 2025;194:1131\u20139. https:\/\/doi.org\/10.1093\/aje\/kwae295.","DOI":"10.1093\/aje\/kwae295"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_014","doi-asserted-by":"crossref","unstructured":"Yang, S, Zhang, L, Khan, K, Travers, J, Huang, R, Jovanovic, VM, et al.. Identification of environmental compounds that may trigger early female puberty by activating human GnRHR and KISS1R. Endocrinology 2024;165:bqae103. https:\/\/doi.org\/10.1210\/endocr\/bqae103.","DOI":"10.1210\/endocr\/bqae103"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_015","doi-asserted-by":"crossref","unstructured":"Stagi, S, De Masi, S, Bencini, E, Losi, S, Paci, S, Parpagnoli, M, et al.. Increased incidence of precocious and accelerated puberty in females during and after the Italian lockdown for the coronavirus 2019 (COVID-19) pandemic. Ital J Pediatr 2020;46:165. https:\/\/doi.org\/10.1186\/s13052-020-00931-3.","DOI":"10.1186\/s13052-020-00931-3"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_016","doi-asserted-by":"crossref","unstructured":"Mondkar, SA, Oza, C, Khadilkar, V, Shah, N, Gondhalekar, K, Kajale, N, et al.. Impact of COVID-19 lockdown on idiopathic central precocious puberty\u00a0\u2013\u00a0experience from an Indian centre. J\u00a0Pediatr Endocrinol Metab 2022;35:895\u2013900. https:\/\/doi.org\/10.1515\/jpem-2022-0157.","DOI":"10.1515\/jpem-2022-0157"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_017","doi-asserted-by":"crossref","unstructured":"Fava, D, Pepino, C, Tosto, V, Gastaldi, R, Pepe, A, Paoloni, D, et al.. Precocious puberty diagnoses spike, COVID-19 pandemic, and body mass index: findings from a 4-year study. J\u00a0Endocr Soc 2023;7:bvad094. https:\/\/doi.org\/10.1210\/jendso\/bvad094.","DOI":"10.1210\/jendso\/bvad094"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_018","doi-asserted-by":"crossref","unstructured":"Chioma, L, Bizzarri, C, Verzani, M, Fava, D, Salerno, M, Capalbo, D, et al.. Sedentary lifestyle and precocious puberty in girls during the COVID-19 pandemic: an Italian experience. Endocr Connect 2022;11:e210650. https:\/\/doi.org\/10.1530\/ec-21-0650.","DOI":"10.1530\/EC-21-0650"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_019","doi-asserted-by":"crossref","unstructured":"Chioma, L, Chiarito, M, Bottaro, G, Paone, L, Todisco, T, Bizzarri, C, et al.. COVID-19 pandemic phases and female precocious puberty: the experience of the past 4\u00a0years (2019 through 2022) in an Italian tertiary center. Front Endocrinol (Lausanne) 2023;14:1132769. https:\/\/doi.org\/10.3389\/fendo.2023.1132769.","DOI":"10.3389\/fendo.2023.1132769"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_020","doi-asserted-by":"crossref","unstructured":"Yesiltepe, MG, Eviz, E, Haliloglu, B, Kirmizibekmez, H, Dursun, F, Ozalkak, S, et al.. The effects of the covid-19 pandemic on puberty: a cross-sectional, multicenter study from Turkey. Ital J Pediatr 2022;48:144. https:\/\/doi.org\/10.1186\/s13052-022-01337-z.","DOI":"10.1186\/s13052-022-01337-z"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_021","doi-asserted-by":"crossref","unstructured":"\u00d6zer, E, \u00c7ak\u0131r G\u00fcndo\u011fan, S, Bitkay, A, \u00d6zt\u00fcrk, N, Ata, N, Birinci, \u015e, et al.. Central precocious puberty in T\u00fcrkiye, 2018\u20132024: national incidence, prevalence, and changes across the COVID-19 period. Front Endocrinol (Lausanne) 2026;17:1773426. https:\/\/doi.org\/10.3389\/fendo.2026.1773426.","DOI":"10.3389\/fendo.2026.1773426"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_022","doi-asserted-by":"crossref","unstructured":"Fu, D, Li, T, Zhang, Y, Wang, H, Wu, X, Chen, Y, et al.. Analysis of the incidence and risk factors of precocious puberty in girls during the COVID-19 pandemic. Int J Endocrinol 2022;2022:9229153. https:\/\/doi.org\/10.1155\/2022\/9229153.","DOI":"10.1155\/2022\/9229153"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_023","doi-asserted-by":"crossref","unstructured":"Komatsu, Y, Kikuchi, N, Nishiyama, K, Ohsugi, K, Shiga, K. Trends in central precocious puberty incidence in Japan during the COVID-19 pandemic. Front Pediatr 2026;14:1769902. https:\/\/doi.org\/10.3389\/fped.2026.1769902.","DOI":"10.3389\/fped.2026.1769902"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_024","doi-asserted-by":"crossref","unstructured":"Vargas Trujillo, M, Rungvivatjarus, T, Klein, KO. Incidence of central precocious puberty declines to pre-pandemic levels post COVID-19 pandemic increase: single-center retrospective review in the United\u00a0States. Front Pediatr 2024;12:1352295. https:\/\/doi.org\/10.3389\/fped.2024.1352295.","DOI":"10.3389\/fped.2024.1352295"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_025","doi-asserted-by":"crossref","unstructured":"Kauffman, AS. Gonadal and nongonadal regulation of sex differences in hypothalamic Kiss1 neurones. J\u00a0Neuroendocrinol 2010;22:682\u201391. https:\/\/doi.org\/10.1111\/j.1365-2826.2010.02030.x.","DOI":"10.1111\/j.1365-2826.2010.02030.x"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_026","doi-asserted-by":"crossref","unstructured":"Galo, E, Castro, S, Amaral, D, Espada, F, Brand\u00e3o, C, Leite, AL, et al.. Idiopathic central precocious puberty in boys: results from a national Portuguese cohort. Horm Res Paediatr 2026:1\u201310. https:\/\/doi.org\/10.1159\/000551720.","DOI":"10.1159\/000551720"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_027","doi-asserted-by":"crossref","unstructured":"Shi, L, Jiang, Z, Zhang, L. Childhood obesity and central precocious puberty. Front Endocrinol (Lausanne) 2022;13:1056871. https:\/\/doi.org\/10.3389\/fendo.2022.1056871.","DOI":"10.3389\/fendo.2022.1056871"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_028","doi-asserted-by":"crossref","unstructured":"Calcaterra, V, Magenes, VC, Hruby, C, Siccardo, F, Mari, A, Cordaro, E, et al.. Links between childhood obesity, high-fat diet, and central precocious puberty. Children (Basel) 2023;10:241. https:\/\/doi.org\/10.3390\/children10020241.","DOI":"10.3390\/children10020241"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_029","doi-asserted-by":"crossref","unstructured":"Neville, RD, Lakes, KD, Hopkins, WG, Tarantino, G, Draper, CE, Beck, R, et al.. Global changes in child and adolescent physical activity during the COVID-19 pandemic: a systematic review and meta-analysis. JAMA Pediatr 2022;176:886\u201394. https:\/\/doi.org\/10.1001\/jamapediatrics.2022.2313.","DOI":"10.1001\/jamapediatrics.2022.2313"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_030","doi-asserted-by":"crossref","unstructured":"Chang, TH, Chen, YC, Chen, WY, Chen, CY, Hsu, WY, Chou, Y, et al.. Weight gain associated with COVID-19 lockdown in children and adolescents: a systematic review and meta-analysis. Nutrients 2021;13:3668. https:\/\/doi.org\/10.3390\/nu13103668.","DOI":"10.3390\/nu13103668"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_031","doi-asserted-by":"crossref","unstructured":"Alonso, GF. Precocious puberty, pandemic and beyond. Pituitary 2024;27:916\u201324. https:\/\/doi.org\/10.1007\/s11102-024-01434-8.","DOI":"10.1007\/s11102-024-01434-8"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_032","doi-asserted-by":"crossref","unstructured":"Madigan, S, Eirich, R, Pador, P, McArthur, BA, Neville, RD. Assessment of changes in child and adolescent screen time during the COVID-19 pandemic: a systematic review and meta-analysis. JAMA Pediatr 2022;176:1188\u201398. https:\/\/doi.org\/10.1001\/jamapediatrics.2022.4116.","DOI":"10.1001\/jamapediatrics.2022.4116"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_033","doi-asserted-by":"crossref","unstructured":"Berson, DM, Dunn, FA, Takao, M. Phototransduction by retinal ganglion cells that set the circadian clock. Science 2002;295:1070\u20133. https:\/\/doi.org\/10.1126\/science.1067262.","DOI":"10.1126\/science.1067262"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_034","doi-asserted-by":"crossref","unstructured":"Touitou, Y, Reinberg, A, Touitou, D. Association between light at night, melatonin secretion, sleep deprivation, and the internal clock: health impacts and mechanisms of circadian disruption. Life Sci 2017;173:94\u2013106. https:\/\/doi.org\/10.1016\/j.lfs.2017.02.008.","DOI":"10.1016\/j.lfs.2017.02.008"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_035","doi-asserted-by":"crossref","unstructured":"Chen, Z, Si, L, Shu, W, Zhang, X, Wei, C, Wei, M, et al.. Exogenous melatonin regulates puberty and the hypothalamic GnRH-GnIH system in female mice. Brain Sci 2022;12:1550. https:\/\/doi.org\/10.3390\/brainsci12111550.","DOI":"10.3390\/brainsci12111550"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_036","doi-asserted-by":"crossref","unstructured":"Boafo, A, Greenham, S, Alenezi, S, Robillard, R, Pajer, K, Tavakoli, P, et al.. Could long-term administration of melatonin to prepubertal children affect timing of puberty? A clinician\u2019s perspective. Nat Sci Sleep 2019;11:1\u201310. https:\/\/doi.org\/10.2147\/nss.s181365.","DOI":"10.2147\/NSS.S181365"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_037","doi-asserted-by":"crossref","unstructured":"Simonneaux, V, Ancel, C, Poirel, VJ, Gauer, F. Kisspeptins and RFRP-3 act in concert to synchronize rodent reproduction with seasons. Front Neurosci 2013;7:22. https:\/\/doi.org\/10.3389\/fnins.2013.00022.","DOI":"10.3389\/fnins.2013.00022"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_038","doi-asserted-by":"crossref","unstructured":"K\u0131l\u0131n\u00e7 U\u011furlu, A, Bideci, A, Demirel, MA, Take Kaplano\u011flu, G, Dayan\u0131r, D, G\u00fclbahar, \u00d6, et al.. Effects of blue light on puberty and ovary in female rats. J\u00a0Clin Res Pediatr Endocrinol 2023;15:365\u201374. https:\/\/doi.org\/10.4274\/jcrpe.galenos.2023.2022-12-1.","DOI":"10.4274\/jcrpe.galenos.2023.2022-12-1"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_039","doi-asserted-by":"crossref","unstructured":"Umano, GR, Maddaluno, I, Riccio, S, Lanzaro, F, Antignani, R, Giuliano, M, et al.. Central precocious puberty during COVID-19 pandemic and sleep disturbance: an exploratory study. Ital J Pediatr 2022;48:60. https:\/\/doi.org\/10.1186\/s13052-022-01256-z.","DOI":"10.1186\/s13052-022-01256-z"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_040","doi-asserted-by":"crossref","unstructured":"Cai, H, Chen, P, Jin, Y, Zhang, Q, Cheung, T, Ng, CH, et al.. Prevalence of sleep disturbances in children and adolescents during COVID-19 pandemic: a meta-analysis and systematic review of epidemiological surveys. Transl Psychiatry 2024;14:12. https:\/\/doi.org\/10.1038\/s41398-023-02654-5.","DOI":"10.1038\/s41398-023-02654-5"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_041","doi-asserted-by":"crossref","unstructured":"Racine, N, McArthur, BA, Cooke, JE, Eirich, R, Zhu, J, Madigan, S. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis. JAMA Pediatr 2021;175:1142\u201350. https:\/\/doi.org\/10.1001\/jamapediatrics.2021.2482.","DOI":"10.1001\/jamapediatrics.2021.2482"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_042","doi-asserted-by":"crossref","unstructured":"Charmandari, E, Tsigos, C, Chrousos, G. Endocrinology of the stress response. Annu Rev Physiol 2005;67:259\u201384. https:\/\/doi.org\/10.1146\/annurev.physiol.67.040403.120816.","DOI":"10.1146\/annurev.physiol.67.040403.120816"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_043","doi-asserted-by":"crossref","unstructured":"Belsky, J, Steinberg, L, Draper, P. Childhood experience, interpersonal development, and reproductive strategy: and evolutionary theory of socialization. Child Dev 1991;62:647\u201370. https:\/\/doi.org\/10.2307\/1131166.","DOI":"10.2307\/1131166"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_044","doi-asserted-by":"crossref","unstructured":"Ellis, BJ. Timing of pubertal maturation in girls: an integrated life history approach. Psychol Bull 2004;130:920\u201358. https:\/\/doi.org\/10.1037\/0033-2909.130.6.920.","DOI":"10.1037\/0033-2909.130.6.920"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_045","doi-asserted-by":"crossref","unstructured":"Sanchez-Garrido, MA, Tena-Sempere, M. Metabolic control of puberty: roles of leptin and kisspeptins. Horm Behav 2013;64:187\u201394. https:\/\/doi.org\/10.1016\/j.yhbeh.2013.01.014.","DOI":"10.1016\/j.yhbeh.2013.01.014"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_046","unstructured":"Li, R, Shang, X, Zhang, T, Yan, S. Childhood obesity and central precocious puberty. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2024;49:1034\u201341."},{"key":"2026100815572197494_j_jpem-2026-0331_ref_047","doi-asserted-by":"crossref","unstructured":"Chang, A, Schnall, AH, Law, R, Bronstein, AC, Marraffa, JM, Spiller, HA, et al.. Cleaning and disinfectant chemical exposures and temporal associations with COVID-19\u00a0\u2013\u00a0National poison data system, United\u00a0States, January 1, 2020\u2013March 31, 2020. MMWR Morb Mortal Wkly Rep 2020;69:496\u20138. https:\/\/doi.org\/10.15585\/mmwr.mm6916e1.","DOI":"10.15585\/mmwr.mm6916e1"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_048","doi-asserted-by":"crossref","unstructured":"Zheng, G, Filippelli, GM, Salamova, A. Increased indoor exposure to commonly used disinfectants during the COVID-19 pandemic. Environ Sci Technol Lett 2020;7:760\u20135. https:\/\/doi.org\/10.1021\/acs.estlett.0c00587.","DOI":"10.1021\/acs.estlett.0c00587"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_049","doi-asserted-by":"crossref","unstructured":"Gore, AC, Chappell, VA, Fenton, SE, Flaws, JA, Nadal, A, Prins, GS, et al.. EDC-2: the Endocrine Society's second scientific statement on endocrine-disrupting chemicals. Endocr Rev 2015;36:E1\u2013e150. https:\/\/doi.org\/10.1210\/er.2015-1010.","DOI":"10.1210\/er.2015-1010"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_050","doi-asserted-by":"crossref","unstructured":"Tice, RR, Austin, CP, Kavlock, RJ, Bucher, JR. Improving the human hazard characterization of chemicals: a Tox21 update. Environ Health Perspect 2013;121:756\u201365. https:\/\/doi.org\/10.1289\/ehp.1205784.","DOI":"10.1289\/ehp.1205784"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_051","doi-asserted-by":"crossref","unstructured":"Richard, AM, Judson, RS, Houck, KA, Grulke, CM, Volarath, P, Thillainadarajah, I, et al.. ToxCast chemical landscape: paving the road to 21st century toxicology. Chem Res Toxicol 2016;29:1225\u201351. https:\/\/doi.org\/10.1021\/acs.chemrestox.6b00135.","DOI":"10.1021\/acs.chemrestox.6b00135"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_052","doi-asserted-by":"crossref","unstructured":"Shen, S, Wang, D, Liu, H, He, X, Cao, Y, Chen, J, et al.. Structural basis for hormone recognition and distinctive Gq protein coupling by the kisspeptin receptor. Cell Rep 2024;43:114389. https:\/\/doi.org\/10.1016\/j.celrep.2024.114389.","DOI":"10.1016\/j.celrep.2024.114389"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_053","doi-asserted-by":"crossref","unstructured":"Wu, Z, Chen, G, Qiu, C, Yan, X, Xu, L, Jiang, S, et al.. Structural basis for the ligand recognition and G protein subtype selectivity of kisspeptin receptor. Sci Adv 2024;10:eadn7771. https:\/\/doi.org\/10.1126\/sciadv.adn7771.","DOI":"10.1126\/sciadv.adn7771"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_054","doi-asserted-by":"crossref","unstructured":"R\u00e1dis-Baptista, G. Do synthetic fragrances in personal care and household products impact indoor air quality and pose health risks? J\u00a0Xenobiot 2023;13:121\u201331. https:\/\/doi.org\/10.3390\/jox13010010.","DOI":"10.3390\/jox13010010"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_055","doi-asserted-by":"crossref","unstructured":"Spencer, PS, Bischoff-Fenton, MC, Moreno, OM, Opdyke, DL, Ford, RA. Neurotoxic properties of musk ambrette. Toxicol Appl Pharmacol 1984;75:571\u20135. https:\/\/doi.org\/10.1016\/0041-008x(84)90194-7.","DOI":"10.1016\/0041-008X(84)90194-7"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_056","doi-asserted-by":"crossref","unstructured":"Arnold, WA, Blum, A, Branyan, J, Bruton, TA, Carignan, CC, Cortopassi, G, et al.. Quaternary ammonium compounds: a chemical class of emerging concern. Environ Sci Technol 2023;57:7645\u201365. https:\/\/doi.org\/10.1021\/acs.est.2c08244.","DOI":"10.1021\/acs.est.2c08244"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_057","doi-asserted-by":"crossref","unstructured":"Yao, Y, Cannava, I, Tazebay, R, Samuels, S, Silverstein, E, Silver, R. Breaching the blood-brain interface: vasoactive neurons contact capillary vessels of the brain clock in the suprachiasmatic nucleus. eNeuro 2026;13. https:\/\/doi.org\/10.1523\/eneuro.0401-25.2026.","DOI":"10.1523\/ENEURO.0401-25.2026"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_058","doi-asserted-by":"crossref","unstructured":"Varatharaj, A, Galea, I. The blood-brain barrier in systemic inflammation. Brain Behav Immun 2017;60:1\u201312. https:\/\/doi.org\/10.1016\/j.bbi.2016.03.010.","DOI":"10.1016\/j.bbi.2016.03.010"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_059","doi-asserted-by":"crossref","unstructured":"Menard, C, Pfau, ML, Hodes, GE, Kana, V, Wang, VX, Bouchard, S, et al.. Social stress induces neurovascular pathology promoting depression. Nat Neurosci 2017;20:1752\u201360. https:\/\/doi.org\/10.1038\/s41593-017-0010-3.","DOI":"10.1038\/s41593-017-0010-3"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_060","doi-asserted-by":"crossref","unstructured":"Yu, S, Fu, L, Lu, J, Wang, Z, Fu, W. Xiao-Yao-San reduces blood-brain barrier injury induced by chronic stress in\u00a0vitro and vivo via glucocorticoid receptor-mediated upregulation of occludin. J\u00a0Ethnopharmacol 2020;246:112165. https:\/\/doi.org\/10.1016\/j.jep.2019.112165.","DOI":"10.1016\/j.jep.2019.112165"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_061","doi-asserted-by":"crossref","unstructured":"Rochfort, KD, Collins, LE, Murphy, RP, Cummins, PM. Downregulation of blood-brain barrier phenotype by proinflammatory cytokines involves NADPH oxidase-dependent ROS generation: consequences for interendothelial adherens and tight junctions. PLoS One 2014;9:e101815. https:\/\/doi.org\/10.1371\/journal.pone.0101815.","DOI":"10.1371\/journal.pone.0101815"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_062","doi-asserted-by":"crossref","unstructured":"Voirin, AC, Perek, N, Roche, F. Inflammatory stress induced by a combination of cytokines (IL-6, IL-17, TNF-\u03b1) leads to a loss of integrity on bEnd.3 endothelial cells in\u00a0vitro BBB model. Brain Res 2020;1730:146647. https:\/\/doi.org\/10.1016\/j.brainres.2020.146647.","DOI":"10.1016\/j.brainres.2020.146647"},{"key":"2026100815572197494_j_jpem-2026-0331_ref_063","doi-asserted-by":"crossref","unstructured":"Sletten, TL, Segal, AY, Flynn-Evans, EE, Lockley, SW, Rajaratnam, SM. Inter-individual differences in neurobehavioural impairment following sleep restriction are associated with circadian rhythm phase. PLoS One 2015;10:e0128273. https:\/\/doi.org\/10.1371\/journal.pone.0128273.","DOI":"10.1371\/journal.pone.0128273"}],"container-title":["Journal of Pediatric Endocrinology and Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpem-2026-0331\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpem-2026-0331\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:58:21Z","timestamp":1791475101000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/jpem-2026-0331\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":63,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,7,27]]},"published-print":{"date-parts":[[2026,10,26]]}},"alternative-id":["10.1515\/jpem-2026-0331"],"URL":"https:\/\/doi.org\/10.1515\/jpem-2026-0331","relation":{},"ISSN":["0334-018X","2191-0251"],"issn-type":[{"value":"0334-018X","type":"print"},{"value":"2191-0251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]}}}