Precocious Puberty: Causes, Diagnosis, Treatment

Puberty is that time period of life when a child’s body brings some changes to become sexually mature. In boys, it happens usually between 12-16 of age and in girls around 10 to 14 years of age but puberty is considered to be precocious when a child attains puberty early in life that is before the age of 8 in girls and 9 in boys. Many times, the physician is not able to find the cause of precocious puberty but known causes include hormones disorders, tumors, etc. About 1 out of every 5000 children is affected by precocious puberty.

Normal Puberty Process

Let’s have a look at the normal process

• Hypothalamus – a small part of the brain which starts producing a hormone during the usual period of puberty which marks the start of puberty.
• Pituitary – under influence of this hormones release gonadotropins
• Sex hormones – gonadotropins act on testes or ovaries to produce sex hormones i.e. estrogen in female and testosterone in males
• Changes: these sex hormones act on different parts of the body and start changing them accordingly.

Signs and symptoms of Precocious Puberty

If normal signs of puberty occur

Before age 9 in boys

• The appearance of facial hair – mustache or beard
• Enlargement of testicles, scrotum, and penis
• The rapid increase in height (growth spurt) – taller than individuals of own age
• The voice becomes deeper (usually a late sign)

Before age 8 in girls

• Breast enlargement (breast tissue growth is usually the first sign of puberty in female)
• First periods – typically 2 to 3 years later after onset of puberty.
• The rapid increase in height (growth spurt) – taller than individuals of own age

Causes of Precocious Puberty

Central precocious puberty or gonadotropin independent puberty – more common in females than males. The process is identical to normal puberty but initiation occurs early than usual

• Idiopathic – most of the time the reason is unknown
• Injury or tumor affecting the brain, spinal cord, or pituitary.
• Birth defects which affect the brain like hydrocephalus

Peripheral precocious puberty or gonadotropin dependent puberty – the abnormality is not present in the hypothalamus, brain or pituitary

• Adrenal gland tumors release sex hormones
• In girls, ovarian cyst or tumors release estrogen
• In boys, testicles tumors release testosterone
• Externally introduced – sometimes hormones can be externally in the child’s body through creams, ointments or injection

Risk factors for Precocious Puberty

Certain children are at higher risk of developing precocious puberty due to

• Gender: girls are 10 times more prone to precocious puberty.
• Race: African American children are at higher risk of developing precocious puberty
• Obesity: Overweight or obese girls suffer from puberty early but fat has no effect on boys
• Medical conditions: Congenital conditions like McCune Albright syndrome or congenital adrenal hyperplasia can lead to complications like precocious puberty
• Family history

Complications of Precocious Puberty

If the precocious puberty is not treated timely, the following can be possible complications

• Short height: though children are taller than individuals of their own age group as they become adult they remain shorter because their bone matures early under the influence of sex hormones
• Stress: They become self-conscious about their body changes and they look more mature than their fellows and ultimately it can lead to stress

Diagnosis of Precocious Puberty

your doctor will ask you some question related to your medical history, conduct a physical exam and medical test to find the cause of your constipation

• Medical history: Your doctor will ask you many questions related to
• Your symptoms and signs, current or past medical illness, medications, bowel habits, physical activity
• Physical examination: Basically, your doctor will
• Check for your Vitals such as blood pressure, temperature, heart rate
• Check for the sound of chest, heart, abdomen
• Will look for breast in girls, and size of testicles and penis in boys.
• Laboratory tests
• Blood test: it is necessary to measure the levels of different hormones. It will help your doctor to find the type of precocious puberty. A common blood test performed is a Gonadotropin-releasing hormone stimulation test, thyroid function test, etc.
• Imaging tests
• X-ray: the x-ray of a child’s wrist can be used to assess the age of bones
• Ultrasound: It can be used to look for ovarian cyst or tumor in a girl
• CT scan: To check for the disorders of adrenal glands like Congenital Adrenal Hyperplasia
• MRI scan: For Gonadotropin dependent precocious puberty, an MRI scan of the brain can be used to rule out any brain lesion

Treatment of Precocious Puberty

The primary goal of the treatment is to slow down the phase of puberty so that your child can reach normal adult height. The treatment depends upon the type and cause

• Treating central precocious puberty: Children with no underlying medical condition can be treated easily by medication easily. It consists of giving your child a monthly injection of a long-acting GnRH analog-like leuprolide. This delays further development. It is most effective if treatment is initiated before the age of 6.

The medications are given to the child until the age of normal puberty. After stopping the medications, the process of puberty starts again after around 16 months.

• Treating the peripheral precocious puberty: Since most of the time, there is a known cause for precocious puberty. Treating the cause can treat the precocious puberty as well. So, the treatment differs for each of the underlying cause as
• Tumor: by surgery or radiation
• Prevent exposures to external sources of hormones.
• By inhibiting the synthesis of steroid hormones – it can be done by drugs such as ketoconazole
• By reducing the effect of the hormone on body tissue – drugs like spironolactone can be used in males

Prognosis of Precocious Puberty

The treatment is successful if started early in life and treated children are socially, psychologically, and medically fine when they become adults.

Reference

• Melmed S. Physiology and disorders of puberty. In: Williams Textbook of Endocrinology. 13th ed. Philadelphia.
• Kliegman RM. Disorders of puberty. In: Nelson Textbook of Pediatrics. 20th ed. Philadelphia.
• Ferri FF. Precocious puberty. In: Ferri’s Clinical Advisor 2017. Philadelphia.
• Pomeranz AJ. Precocious puberty in the male. In: Pediatric Decision-Making Strategies. 2nd ed. Philadelphia.