Precocious Puberty

Puberty is the time in life when the body shows signs of change from being a child to becoming an adult. During this period the child changes physically, hormonally and sexually. Precocious puberty is an uncommon condition that occurs when puberty begins before the age of eight in girls and before age nine in boys.

Studies amply reveal that precocious puberty is noticed all over the world. The pattern that seems to be emerging is that one girl out of six eight year olds in the USA, Australia and Britain is racing into puberty. It is observed that precocious puberty affects Africans and Americans more than other races. Overweight / obese children run a higher risk of developing precocious puberty than normal children.

Signs and symptoms of precocious puberty

• Development of breasts
  
• Hair development underarm or in public parts
  
• Rapid height growth
  
• Onset of menstruation
  
• Acne
  
• Adult body odor

In Boys:

• Enlargement of testicles
  
• Hair growth in face (usually grows first on the upper lip), public parts /underarm
  
• Rapid height gain
  
• Deepening of voice
  
• Acne
  
• Adult body odor.

In some children 'partial' precocious puberty could be seen. Girls may show breast development that later disappears or may persist without any other physical changes of puberty. Such children with partial precocious puberty should be evaluated by a medical professional to rule out any other health problems. By and large such instances do not require any treatment and usually will show the other expected signs of puberty at the right age.

Causes for Precocious Puberty

Abnormalities in ovary and testicles may contribute to precocious puberty. Problems in the ovaries, thyroid gland disorders can also cause the onset of puberty ahead of schedule.

Sometimes precocious puberty is the result of a structural problem in the brain such as a tumor, brain injury due to head trauma, infection such as meningitis that triggers puberty to begin early. In a majority of girls there is no underlying medical problem but they simply start puberty too early for no known reason. Certain types of environmental contamination like environmental toxins could play a role in causing precocious puberty.

Central precocious puberty

• Tumor in the brain or spinal cord
  
• Infection such as encephalitis or meningitis
  
• A birth defect in the brain such as hydrocephalus or hamartoma (tumor)
  
• Radiation to brain or spinal cord
  
• Injury to brain or spinal cord
  
• Ischemia
  
• McCune Albright Syndrome - a genetic disease that affects the bones and skin color and causes hormonal problems
  
• A group of inherited disorders known as Congenital adrenal Hyperplasia which involves abnormal hormone production by the adrenal glands.
  
• Hypothyroidism - a condition when the thyroid glands do not produce adequate hormones.

Peripheral precocious puberty

This type is less common than central precocious puberty. This is caused due to the release of estrogen or testosterone into the body due to various problems with ovaries, testicles, adrenal glands or pituitary gland.

Diagnosis of precocious puberty

The doctor who specializes in hormone related conditions in children is called pediatric endocrinologist. It is better to consult such a specialist in case of suspicion of precocious puberty. The consulting doctor first reviews the child's medical history, performs a complete physical examination and certain blood tests to measure hormone levels.

Physical examinations show evidence of changes and signs of early sexual maturation including breast development, rapid height growth, menstruation, acne, enlarged testicles or penis and public and underarm hair. X rays of the child's hand and wrists are taken which is an important clue in diagnosing precocious puberty condition. The X rays help determine the child's bone age and these shows if the bones are growing too quickly or not.

After the initial diagnosis the type of precocious puberty is established. The child is injected with GnRH hormone after which a blood sample is taken. Children with central precocious puberty show an increase in LH and FSH hormone levels whereas in children with peripheral precocious puberty, the LH and FSH levels continue to remain the same.

Magnetic Resonance Imaging (MRI) of the brain is also done for children who have central precocious puberty. This reveals any brain abnormalities. Thyroid tests are also done to rule out hypothyroidism. Sometimes abdominal ultrasound is also advised to check for an ovarian cyst or tumor.

Complications due to precocious puberty

Height problems: Children with precocious puberty suffer short height. Although they may grow quickly at first, they stop growing earlier than usual and this causes them to be shorter than average as adults.

Polycystic ovary syndrome: Girls who begin menstruating before age eight, show increased risk of developing hormone disorder later during puberty. Polycystic syndrome is again a disorder involving irregular menstrual periods and excess androgen levels. Here the ovaries develop cysts but fail to release eggs.

Treatment of Precocious puberty

Most often treatment for precocious puberty depends on its cause. There are two possible approaches to treatment depending on the cause.

• Treating the underlying cause or disease such as tumor
  
• Lowering the level of sex hormones with medication to stop sexual development from progressing.

If an underlying medical condition is the cause of precocious puberty, treatment for that condition is needed to stop progress of puberty. In case the child has a tumor that is producing hormones and causing precocious puberty, the progression of puberty will stop when the tumor is surgically removed.

Children suffering from precocious puberty without any underlying medical condition can be simply treated with medication. This treatment is called GnRH analogue therapy and it includes a monthly injection of a medication such as leuprolide. This medication helps to stop HPG axis and delays further development. The child is recommended to stay on this medication until he or she reaches the normal age of puberty. Once this medication is stopped, the process of puberty is onset.

Treatment for precocious puberty helps to stop puberty until the child is closer to the normal time for sexual development. Otherwise there is always the danger that the child may not reach his or her full potential growth in terms of physical and mental development.

Management of precocious puberty

Although certain risk factors of precocious puberty like sex and race cannot be avoided, certain other factors can be reduced. Children should be encouraged to maintain a healthy weight. Children should be kept away from external sources of estrogen and testosterone.

Children suffering from precocious puberty may feel different from their peer group and this can cause social and emotional trauma in the young ones' minds. Depression, substance abuse and low self esteem are some of the problems that widely occur in children with this condition. If it is difficult for the young child and the family to cope up with such a situation then it would be best to seek counseling help. Psychological counseling can definitely help family better understand and handle emotions and challenges that accompany precocious puberty.

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