Precocious Puberty (Early Puberty)

What is precocious puberty (early puberty)?

Abnormally early puberty is called precocious puberty and is characterized by the early development of sexual characteristics in girls before the age of 8 and in boys before the age of 9. Most children with the disorder grow fast at first, but may finish growing before reaching their full genetic height potential.

What causes precocious puberty?

Early puberty and sexual development may be caused by tumors or growths of the ovaries, adrenal glands, pituitary gland, or brain. Other causes may include central nervous system abnormalities, family history of the disease, or certain rare genetic syndromes. In many cases, no cause can be found for the disorder. Two types of precocious puberty include the following:

• Gonadotropin-dependent precocious puberty. Also known as central precocious puberty, this form of precocious puberty is the most common, affecting most girls with the disorder and half of boys with the disorder. The puberty is triggered by the premature secretion of gonadotropins (hormones responsible for puberty). Researchers believe that the premature maturation of the hypothalamus-pituitary-ovarian axis causes this disorder in girls. However, in the majority of cases, no cause for the early secretion of gonadotropin hormones can be found.

• Gonadotropin-independent precocious puberty. This is a form of precocious puberty that is not triggered by the early release of gonadotropin hormones.

What are the symptoms of precocious puberty?

The following are the most common symptoms of precocious puberty. However, each child may experience symptoms differently. As in normal puberty, symptoms of precocious puberty include the onset of secondary sexual characteristics, including:

• Girls:

  • Breasts

  • Pubic and underarm hair

  • Menstruation

  • Ovulation

• Boys:

  • Enlarging penis and testicles

  • Pubic and underarm hair

  • Facial hair

  • Spontaneous erections

  • Production of sperm

  • Development of acne

  • Deepening of the voice

Other characteristics of the disorder include:

• Typical moodiness associated with the hormonal changes

• Increased aggression

• Taller than peers, at first

How is precocious puberty diagnosed?

In addition to a complete medical history and physical examination of your child, diagnosis of precocious puberty may include:

• Measurement of gonadotropins (LH and FSH), estradiol, testosterone, and/or thyroid hormones.

• X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. A bone X-ray may be performed to determine bone age.

• Ultrasound (also called sonography) of the adrenal glands and gonads (ovaries and testes). This diagnostic imaging technique uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

• Gonadotropin-stimulating hormone (GnRH stimulation test). This hormone, produced by the hypothalamus in the brain, stimulates the pituitary gland to release gonadotropins, which, in turn, stimulate the production of sex hormones from the gonads. This stimulation test will determine the form of precocious puberty (gonadotropin-dependent or gonadotropin-independent).

• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

What is the treatment for precocious puberty?

Specific treatment for precocious puberty will be determined by your child's doctor based on:

• Your child's age, overall health, and medical history

• Extent of the condition

• Your child's tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of early puberty symptoms. Treatment will also depend on the type of precocious puberty, age of the child, and the underlying cause, if known.

New developments in hormone treatments for precocious puberty have led to the successful use of synthetic GnRH. This synthetic hormone appears to stop the sexual maturation process brought on by the disorder by halting the pituitary gland from releasing the gonadotropin hormones.

What is the emotional effect of precocious puberty on a child?

Early puberty will cause a child's body to change much sooner than his or her peers. This sense of being different, coupled with the hormonal change-induced emotional mood swings, may make a child feel self-conscious. Your child may feel uncomfortable about his or her sexual changes, as well. Helping your child cope with teasing from his or her peers, treating your child appropriately for his or her age, and boosting your child's self-esteem are important steps to help your child adjust more appropriately.