Precocious Puberty
Erica A. Eugster, MD and Mark R. Palmert, MD, PhD
What is puberty?
The Puberty is the period of life when children become adults. It usually starts between 8 and 13 years in girls, and between 9 and 14 in boys. In some children, there are environmental and racial factors that make them enter to puberty six months earlier than other children.
Puberty involves:
- The development of the gonads (e.g., ovaries in girls and testes in boys).
- The development of secondary sexual characteristics (e.g., growth of axillary and pubic hair, breast development and the growth of the penis and testicles).
- Growth ("spurt") of bones and muscles.
- Changes in body shape and size.
The main hormones responsible for puberty are the gonadotropins and sex steroids (testosterone and estrogen). A part of the brain, called the hypothalamus, secretes gonadotropin releasing hormone (GnRH). This hormone stimulates the pituitary gland to throw two gonadotropins: luteinizing hormone or luteinizing (LH) and follicle stimulating hormone (FSH). These gonadotropins then stimulate the gonads to produce sexual steroids - estrogen in women and testosterone in men - which produce physical changes that occur during puberty.
The adrenal glands also play a role in the production of sexual steroids, but its function is generally much less important than that of the gonads.
What is precocious puberty?
The precocious puberty has been traditionally defined as the appearance of any sign of a secondary sexual characteristic in boys younger than 9 years and girls under 8. However, in most of these children, early puberty is a variation of normal and there is no medical problem.
Also as there are differences between the age of the beginning, there are differences in the duration of puberty. Children with early or late puberty often have family precedents.
Near the end of puberty, growth stops. As the bones of children with precocious puberty mature and stop growing at a younger age than normal, it may be of shorter stature than expected when they become adults. Precocious puberty can also cause emotional and social problems for children who are more sexually mature than others who not.
Signals of precocious puberty
Girls:
- Breast development.
- Vaginal bleeding.
Boys:
- Growth of the testes and penis.
- Facial hair.
- Voice change .
Girls and Boys:
- Axillary or pubic hair.
- Rapid growth - a “spurt growth”.
- Acne .
- Adult body odor.
What causes early puberty?
Not all forms of precocious puberty are dangerous. For example, premature thelarche refers to breast development in very young children, and premature adrenarche refers to pubic or axillary hair in boys and girls. These conditions are not well understood but do not represent an underlying medical condition.
There are two types of precocious puberty that can be dangerous. The first is called Central Precocious Puberty (CPP) and the second is Peripheral Precocious Puberty (PPP).
The CPP occurs when the hypothalamus releases GnRH and activates very early the HPG axis (or puberty). In most girls with CPP, there is an underlying medical problem. In boys, the condition is less common and is more likely to be related to a medical problem such as a tumor, a brain trauma (e.g., a blow to the head, surgery, radiation therapy), or inflammation (e.g., meningitis).
The PPP, which occurs rarely, is due to excessive production of sex steroids (estrogen and testosterone) due to problems in the ovaries, testes or adrenal glands. It can also be caused by contact with sex hormones (e.g., estrogen cream or testosterone).
How does early puberty is diagnosed and treated?
Treatment of precocious puberty depends on whether it is CPP or PPP. To reach a diagnosis, your doctor will take a medical history, do a physical exam and blood tests to measure hormone levels, and take x-rays (if necessary) to see if the bones are maturing too fast. Sometimes a test of "stimulation" is done to determine if puberty is activated.
For CPP, there are medications that controls the HPG axis and prevents further pubertal development. For PPP, treatment depends on the cause and may include medicines, surgery, or removal of the external hormones (e.g, estrogen cream).
What should you do with this information?
If your child has any sign of early puberty, consult a pediatric endocrinologist, who is an expert in the treatment of hormone-related conditions in children. Precocious puberty has to be addressed to ensure that there is no underlying cause. Your doctor will work with you to determine the best treatment option.
Taken from: http://jcem.endojournals.org/content/91/9/0.2.full