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Precocious Puberty
Introduction
Puberty is the time in life when your body changes from that of a child to an adult. It includes rapid growth of bones and muscles, changes in body shape and size, and development of your body's ability to reproduce. Puberty normally takes place in girls between ages 8 and 16 and in boys between ages 9 and 14.
Precocious puberty is when the physical changes of puberty begin before age 8 for girls and before age 9 for boys. An uncommon condition, precocious puberty occurs more often in girls than in boys. In most cases, the cause of precocious puberty is unknown. Rarely, underlying medical conditions — such as infections, hormone disorders, tumors, brain abnormalities or injuries — may cause precocious puberty.
Prompt medical evaluation of precocious puberty is important to rule out an underlying cause and begin treatment. Although treatment varies depending on the cause, it often includes medication to delay further development. In addition to medical treatment, children with precocious puberty may also benefit from psychological counseling to deal with the effects of being more sexually developed than their peers.
Signs and symptoms
Signs of precocious puberty include development of the following before age 8 in girls and before age 9 in boys.
Girls
- Breast growth.
- First period (menstruation).
- Enlarged testicles and penis.
- Facial hair (usually grows first on the upper lip).
- Deepening voice.
- Pubic or underarm hair.
- Rapid growth.
- Acne.
- Adult body odor.
To understand what causes precocious puberty in some children, it's helpful to know what causes puberty to begin. A complex process known as the hypothalamic-pituitary-gonadal (HPG) axis governs when puberty occurs in your body. This process involves the following steps:
- Your brain starts the process. Part of your brain called the hypothalamus makes gonadotropin-releasing hormone (GnRH).
- The pituitary gland releases more hormones. GnRH causes your pituitary gland (a small bean-shaped gland at the base of your brain) to release two more hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
- Sex hormones are produced. LH and FSH cause the ovaries to produce estrogen — hormones involved in the growth and development of female sexual characteristics — and the testicles to produce testosterone — hormones responsible for the growth and development of male sexual characteristics. The adrenal glands — a pair of glands located atop your kidneys — also begin to make estrogen and testosterone.
- Physical changes occur. The production of estrogen and testosterone in your body causes the physical changes of puberty.
Central precocious puberty
In this type of precocious puberty, the entire HPG axis simply starts too soon. Although they begin earlier than they should, the pattern and timing of the steps in the process are normal. For the majority of children with this condition, there's no underlying medical problem and no reason that can be identified for the HPG axis to begin when it did.
In rare cases, the following may be the cause of central precocious puberty:
- A tumor in the brain or spinal cord (central nervous system).
- An infection, such as encephalitis or meningitis.
- A defect in the brain present at birth, such as excess fluid build-up (hydrocephalus) or a noncancerous tumor (hamartoma).
- Radiation to the brain or spinal cord.
- Injury to the brain or spinal cord.
- An obstruction of blood flow to the brain (ischemia).
- McCune-Albright syndrome — a genetic disease that affects bones and skin color and causes hormonal problems.
- Congenital adrenal hyperplasia — a group of inherited disorders involving abnormal hormone production by the adrenal glands.
- Hypothyroidism — a condition in which your thyroid gland doesn't produce enough hormones.
This type of precocious puberty, which is less common than central precocious puberty, happens without GnRH. Instead, the cause is release of estrogen or testosterone into the body because of problems with the ovaries, testicles, adrenal glands or pituitary gland.
In both girls and boys, the following may lead to peripheral precocious puberty:
- A tumor in the adrenal glands or in the pituitary gland that secrets estrogen or testosterone.
- McCune-Albright syndrome.
- Exposure to external sources of estrogen or testosterone, such as creams or ointments.
- Ovarian cysts.
- Ovarian tumors.
- A tumor in the cells that make sperm (germ cells) or in the cells that make testosterone (Leydig cells).
- A rare disorder called familial gonadotropin-independent sexual precocity, which is caused by a defect in a gene and which can result in the early production of testosterone in boys, usually between ages 1 and 4.
Treatment for precocious puberty depends on the cause. Most children with central precocious puberty, in which there's no underlying medical condition, can be effectively treated with medication. This treatment, called GnRH analogue therapy, usually includes a monthly injection of a medication, such as leuprolide, which stops the HPG axis and delays further development. The child stays on this medication until he or she reaches the normal age of puberty. Once he or she stops receiving the medication, the process of puberty begins again.
If an underlying medical condition is causing your child's precocious puberty, treatment of that condition is necessary to stop the progress of puberty. For example, if a child has a tumor that's producing hormones and causing precocious puberty, the progression of puberty usually will stop when the tumor is surgically removed.
Prevention
Some of the risk factors for precocious puberty, such as sex and race, can't be avoided. But, there are things you can do to reduce your child's chances of developing precocious puberty, such as keeping your child away from external sources of estrogen and testosterone — prescription medications for adults in the house or dietary supplements containing estrogen or testosterone, for example — and encouraging your child to maintain a healthy weight.
Information obtained from National Institute of Health