Precocious Puberty

What is precocious puberty?

Puberty that happens early is called precocious puberty. This means a child's physical signs of sexual maturity develop too soon. This includes breast growth, pubic hair, and voice changes. These are known as secondary sexual characteristics. Precocious puberty happens before age 8 in girls, and before age 9 in boys. Most children with the disorder grow fast at first. But they also stop growing before reaching their full genetic height potential.

What causes precocious puberty?

It may be caused by tumors or growths on the ovaries, adrenal glands, pituitary gland, or brain. Other causes may include central nervous system problems, family history of the disease, or certain rare genetic syndromes. In many cases, no cause can be found for the disorder. There are two types of precocious puberty:

• Gonadotropin-dependent. This is also known as central precocious puberty. This is the most common type of precocious puberty. Most girls and half of boys with precocious puberty have this type. The puberty is started by early secretion of hormones called gonadotropins. Gonadotropins include luteinizing hormone (LH) and follicle stimulation 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.
• Gonadotropin-independent. This is a form of precocious puberty that is not started by the early release of gonadotropins. Instead it’s caused by early secretion of high levels of sex hormones. These include the male androgens and female estrogens.

Who is at risk for precocious puberty?

A child is at risk for precocious puberty if he or she has any of these:

• Tumors or growths on the ovaries, testes, adrenal glands, pituitary gland, or brain
• Central nervous system problems
• Family history of the disease
• A rare genetic syndrome

What are the symptoms of precocious puberty?

The signs are secondary sexual characteristics that happen early.

Common signs in girls can include:

• Breast growth
• Pubic and underarm hair
• Menstruation
• Ovulation

Common signs in boys can include:

• Enlarging penis and testicles
• Pubic and underarm hair
• Facial hair
• Spontaneous erections
• Production of sperm
• Acne
• Deepening of the voice

Other signs of the disorder include:

• Moodiness
• Increased aggression
• Growing taller earlier than other classmates

The signs of precocious puberty can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

How is precocious puberty diagnosed?

The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. He or she will give your child a physical exam.

Your child may have blood tests to measure levels of hormones such as:

• Luteinizing hormone (LH)
• Follicle stimulation hormone (FSH)
• A form of estrogen called estradiol
• Testosterone
• Thyroid hormones

Gonadotropin-stimulating hormone (GnRH) is made by the hypothalamus in the brain. It causes the pituitary gland to release gonadotropins. These then cause sex hormones to be made by the ovaries in girls, or the testes in boys. The GnRH blood test may show the type of precocious puberty.

Your child may also have tests such as:

• X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child's bone age. With precocious puberty, bone age is often older than calendar age.
• Ultrasound (sonography). This test uses sound waves and a computer to create images of blood vessels, tissues, and organs. This may be done to look at the adrenal glands and ovaries or testes. 
• MRI. This test uses large magnets and a computer to make detailed images of tissues in the body.

How is precocious puberty treated?

The goal of treatment for is to stop the onset of early puberty signs. In some cases, the signs can be reversed. Treatment will depend on the type of precocious puberty and the cause.

Treatment may be done with synthetic gonadotropin-releasing hormone. This can stop the sexual maturity process. It does this by stopping the pituitary gland from releasing the gonadotropin hormones.

What are possible complications of precocious puberty?

Early puberty will cause a child's body and moods to change much sooner than his or her friends and classmates. This may make a child feel self-conscious and embarrassed, or be teased by other children.

How to manage precocious puberty

You can help your child by treating your child like normal, boosting your child's self-esteem, and seeking a child counselor if more help is needed.

When should I call my child's healthcare provider?

Call your child’s healthcare provider if you see signs of sexual development in a girl before age 8 or in a boy before age 9.

Key points about precocious puberty

• Puberty that happens early is called precocious puberty. This means a child's physical signs of sexual maturity develop too soon. Precocious puberty happens before age 8 in girls, and before age 9 in boys.
• Signs can include breast growth, pubic hair, and voice changes. 
• It may be caused by tumors or growths on the ovaries, adrenal glands, pituitary gland, or brain. In many cases, no cause can be found for the disorder.
• Treatment may be done with synthetic gonadotropin-releasing hormone. This can stop the sexual maturity process.
• Early puberty may make a child feel self-conscious and embarrassed, or be teased by other children.
• You can help your child by treating your child like normal, boosting your child's self-esteem, and seeking a child counselor if more help is needed.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.