KnowYourDisease.Com Precocious Puberty, Causes, Symptoms, Treatment, Definition, Signs, Effects Of Early Puberty, Precocious Puberty Effects, Precocious Puberty Emedicine, Precocious Puberty Syndrome, Precocious Puberty Tumor, Hormones And Early Puberty
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Precocious Puberty

Definition:
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.

Causes:
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.

The reason this process begins early in some children depends on the type of precocious puberty they have: central precocious puberty or peripheral precocious 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

Peripheral precocious puberty
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

In girls, peripheral precocious puberty may also be associated with :

  • Ovarian cysts
  • Ovarian tumors

In boys, peripheral precocious puberty may also be caused by :

  • 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

Risk Factor :
Factors that increase a child's risk of precocious puberty include :

  • Sex. Girls are much more likely than boys to develop precocious puberty.
  • Race. Precocious puberty affects African-Americans more often than others.
  • Obesity. If your child is significantly overweight, he or she has a higher risk of developing precocious puberty than other children do.
  • Exposure to sex hormones. Coming in contact with an estrogen or testosterone cream or ointment, or other substances that contain these hormones (such as an adult's medication or dietary supplements), can increase your child's risk of developing precocious puberty.
  • Other medical conditions. Precocious puberty may be a complication of McCune-Albright syndrome or congenital adrenal hyperplasia — conditions that involve abnormal production of the male hormones (androgens). In rare cases, precocious puberty may also be associated with hypothyroidism.

When to seek medical advice :
Make an appointment with your child's health care provider for an evaluation if your child has signs of precocious puberty, which include development of any of the following before age 8 in girls and before age 9 in boys.

Girls

  • Breast growth
  • First period (menstruation)

Boys

  • Enlarged testicles and penis
  • Facial hair (usually develops first on the upper lip)
  • Deepening voice

Both girls and boys

  • Pubic or underarm hair
  • Rapid growth
  • Acne
  • Adult body odor

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)

Boys

  • Enlarged testicles and penis
  • Facial hair (usually grows first on the upper lip)
  • Deepening voice

Both girls and boys

  • Pubic or underarm hair
  • Rapid growth
  • Acne
  • Adult body odor

Diagnosis:
If your child's doctor suspects precocious puberty, he or she may refer you to a doctor who specializes in the treatment of hormone-related conditions in children (pediatric endocrinologist).

To diagnose precocious puberty, the doctor will first review your child's medical history, do a physical exam and run blood tests to measure hormone levels. X-rays of your child's hand and wrist also are important for diagnosing precocious puberty. These X-rays can help the doctor determine your child's bone age, which shows if the bones are growing too quickly.

Once an initial diagnosis has been made, the doctor will need to find out which type of precocious puberty your child has. To do so, he or she will perform a test that involves injecting your child with GnRH hormone and then taking a blood sample. In children with central precocious puberty, a GnRH injection causes LH and FSH hormone levels to rise. In children with peripheral precocious puberty, LH and FSH hormone levels stay the same.

Magnetic resonance imaging (MRI) of the brain is usually done for children who have central precocious puberty to see if any brain abnormalities are causing the early start of puberty. The doctor may also test your child's thyroid if he or she shows any signs of hypothyroidism.

Other tests also are necessary for children with peripheral precocious puberty to find the cause of their condition. For example, the doctor may run additional blood tests to further examine hormone levels or, in girls, he or she may do an abdominal ultrasound to check for an ovarian cyst or tumor.

Complications :
Possible complications of precocious puberty include :

  • Short height. Children with precocious puberty may grow quickly at first and be tall, compared with their peers. But, because their bones mature more quickly than normal, they often stop growing earlier than usual. This can cause them to be shorter than average as adults. Early treatment of precocious puberty, especially when it occurs in very young children, can help them attain more height than they would without treatment.
  • Polycystic ovary syndrome. Girls who begin menstruating before the age of 8 are at increased risk of developing this hormone disorder later on during puberty. Polycystic ovary syndrome is a disorder involving irregular menstrual periods and excess androgen levels. The ovaries develop cysts and may fail to release eggs.

Complications of hypogonadism
Other complications arise from hypogonadism, a condition in which your sex organs don't secrete sufficient amounts of the sex hormones testosterone (males) and estrogen and progesterone (females). These may include :

  • Sterility. Although there have been a few reports of women with Prader-Willi syndrome becoming pregnant, most people with this disorder are unable to have children (sterile).
  • Osteoporosis. Osteoporosis refers to weakened and brittle bones. Children with Prader-Willi syndrome are at an increased risk of developing osteoporosis because they have low levels of sex hormones, which help maintain strong bones.

Eating large amounts of food quickly, called binge eating, can cause your child's stomach to become abnormally distended (gastric dilatation). Rarely, an abnormally distended stomach can cause the stomach wall to rupture, which can be fatal.

Treatment:
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.

 
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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