Also known as pubertas praecox or sexual precocity.
This is a condition in which a child’s body begins to change into that of an adult (puberty) too soon. When puberty begins before the age of 8 in girls and before the age of 9 in boys that is precocious puberty.
Symptoms of precocious puberty.
Precocious puberty signs and symptoms include development of the following before age 8 in girls and age 9 in boys.
– Breast growth and first period in girls.
– Enlarged testicles and penis, facial hair and deepening of the voice in boys.
– Pubic or underarm hair.
– Rapid growth.
– Adult body odor.
Causes of precocious puberty.
Precocious puberty such as central precocious puberty can be caused by central nervous system ( craniopharyngioma, glioma etc).
It may be caused by tumors or growth on ovaries, adrenal glands, pituitary gland or brain. Other causes include central nervous system problems, family history of the disease or certain rare genetic syndromes. In most cases no cause can be found for the disorder. There are two types of precocious puberty.
1. Gonadotropic dependant.
Also known as central precocious puberty. It is the most common type of precocious puberty. Most girls and half boys have this type. The puberty is started by early secretion of hormones called gonadotropins. Gonadotropins include luteinizing hormone (LH) and follicle stimulating hormone ( FSH). In girls, precocious puberty may be caused by the early maturity of the hypothalamus, pituitary glands and ovaries. But in most cases, no cause can be found.
2. Gonadotropic independent.
This is a form of precocious puberty that is not started by early release of gonadotropins. Instead it is caused by early secretion of high levels of sex hormones. These include the male androgens and female estrogens.
Diagnosis of precocious puberty.
Normal puberty begins with hypothalamus production of kisspeptin which stimulate the pulsatile release gonatropic hormones from the hypothalamus. This results in an increase in the frequency and magnitude of LH hormones. The diagnosis include;
Blood test to check the level of hormones such as gonadotropins ( luteinizing hormone (LH) and follicle stimulating hormone (FSH), estradid, testosterone, dehydroepiandrosterone sulphate(DHEAS) and thyroid hormones.
A gonadotropin releasing hormone against (GnRHa) stimulation test which can tell whether a child’s precocious puberty is gonadotropin dependant or gonadotropin independent.
Measuring blood 17 hydroxyprogesterone to test for congenital adrenal hyperplasia.
A bone x-ray to determine if bones are growing at normal rate.
The doctor may also use imaging techniques to rule out tumor or other organ abnormality as a cause. They include;
1. Ultrasound (sonography) to examine the gonads. An ultrasound creates an image on a computer screen of blood vessels and tissues, allowing the doctor monitor organs and blood flow in real time.
2. An MRI( magnetic resonance image) scan of the brain and pituitary gland using an instrument that produces detailed images of organs and bodily structures.
Treatment of precocious puberty.
1. Injections- are given as monthly shots into the muscles or daily shots given under the skin.
2. Implants – are tiny tubes a little over an inch long, placed under the skin, usually in the upper arm. They gradually release medicine into the body.
3. Nasal sprays – are given daily.
During the first month of treatment, the signs of puberty might actually become more pronounced. But after that, they will go away. In girls, the breasts will have shrunk after 6- 12 months of treatment.
Side effects are mild they include; menopausal symptoms such as hot flashes, headaches etc.
Other treatment for central precocious puberty include;
Progestin – injections of progestin used to as the standard treatment.
Other treatments – surgery and radiation might be necessary in cases where central precocious puberty has been triggered by a brain tumor. Removing tumor won’t always resolve all the symptoms.