Precocious puberty

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.