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Precocious puberty refers to the early onset of sexual development in children, occurring before the typical age of 8 in girls and 9 in boys. This condition arises when the pituitary gland releases gonadotropins, stimulating the development of the ovaries in girls and the testes in boys. Consequently, girls experience an increase in estrogen production, and boys in testosterone. While it’s worth noting that factors like ethnicity can influence the natural timing of puberty, when it occurs significantly earlier than expected for a child’s age, it is termed precocious puberty.
Signs of precocious puberty include rapid growth in muscles and bones, alterations in body shape and size, and the acquisition of reproductive capabilities. Though the precise cause is often unknown, in rare cases, conditions such as infections, hormonal imbalances, brain tumors, or injuries can trigger precocious puberty.
Treatment typically involves the use of medications that delay the progression of puberty by regulating sex hormone release, allowing for more time for normal physical and emotional growth. Early identification and intervention are vital to ensure children with precocious puberty receive the necessary medical care to manage their condition effectively and support their overall well-being.
Symptoms
Symptoms of precocious puberty include:
- Early breast development and the first menstrual period in girls.
- Testicle and penis growth, facial hair, and a deeper voice in boys.
- Development of pubic or underarm hair.
- Rapid growth.
- Acne.
- Adult-like body odor.
If your child exhibits any of these signs, it is advisable to schedule an appointment with their healthcare provider to address potential precocious puberty.
Causes
Peripheral precocious puberty is a condition where the body starts producing estrogen or testosterone too early, without the usual involvement of the hormone GnRH that triggers puberty. This early hormone release can occur due to issues in various organs like the ovaries, testicles, adrenal glands, or pituitary gland. There are some possible causes of peripheral precocious puberty:
- Tumors: Sometimes, tumors in the adrenal glands or pituitary gland can release excess estrogen or testosterone, leading to this condition.
- Genetic diseases: A rare genetic disorder called McCune-Albright syndrome, which affects bones and skin color, can cause hormonal imbalances and trigger peripheral precocious puberty.
- Exposure to hormones: Using creams or ointments that contain estrogen or testosterone can also disrupt the normal timing of puberty.
In girls, peripheral precocious puberty may also be associated with:
- Ovarian cysts: Abnormal growths in the ovaries.
- Ovarian tumors: Unusual masses in the ovaries.
In boys, it can be caused by:
- Tumors: Tumors affecting the cells responsible for sperm or testosterone production.
- Genetic conditions: A rare genetic condition called gonadotropin-independent familial sexual precocity, which typically occurs in boys aged 1 to 4 and leads to early testosterone production.
Risk factors
There are several factors that can elevate the risk of experiencing precocious puberty:
- Gender. Precocious puberty is more likely to occur in girls than in boys.
- Obesity. Precocious puberty risk is increased by excess weight.
Diagnosis
To diagnose precocious puberty in a child, several medical evaluations are performed, which typically involve:
- Reviewing medical histories:
- Reviewing the medical histories of both the child and the family.
- Blood tests:
- Gonadotropin-Releasing Hormone (GnRH) Stimulation Test: This test helps determine the type of precocious puberty. It includes taking a blood sample and administering a GnRH hormone injection. Subsequent blood samples reveal how the child’s hormones respond.
- Hormone level checks: Assessing hormone levels in the bloodstream.
- Thyroid testing: This test checks for hypothyroidism by examining thyroid hormone production. It is recommended if the child exhibits symptoms like fatigue, sensitivity to cold, declining school performance, or dry skin.
- Imaging studies:
- Magnetic Resonance Imaging (MRI) of the brain: This imaging technique is used to identify any brain-related issues that might be triggering early puberty in children with central precocious puberty.
- X-rays of hands and wrists: These X-rays help diagnose precocious puberty by examining bone growth patterns.
- Pelvic and adrenal gland ultrasound: This ultrasound scan evaluates the pelvis and adrenal glands for any abnormalities associated with precocious puberty.
Treatment
The primary objective in managing precocious puberty among children is to ensure they reach their adult height. The choice of treatment depends on the underlying cause, and when no specific cause is identified, the necessity for treatment hinges on the child’s age and the rate of puberty progression. In cases, where the cause is not apparent, a period of observation over several months may be considered.
- Treatment for central precocious puberty: Central precocious puberty is typically addressed through GnRH analogue therapy, aimed at delaying further development. This therapy may involve monthly injections of medications such as leuprolide acetate (Lupron Depot) or triptorelin (Trelstar, Triptodur Kit). Alternatively, newer formulations with longer intervals between doses are available. Children receive this medication until they approach the usual onset age of puberty. When treatment is discontinued, puberty resumes. Another option for managing central precocious puberty is a histrelin implant, lasting up to a year. Unlike monthly injections, this method doesn’t require frequent shots but necessitates minor surgery to place the implant under the skin of the upper arm. After a year, the implant is removed, and if needed, a new one can be inserted.
- Treatment of underlying medical conditions: When an underlying medical condition triggers precocious puberty, addressing the root cause is essential to stop premature puberty. For example, if a tumor secretes hormones that induce precocious puberty, removing the tumor typically results in the cessation of puberty symptoms.
