Precocious Puberty

Precocious puberty is a condition wherein puberty occurs at a very young age, before age nine for boys and age eight in girls.

Puberty normally happens at around ages 10-12 in boys and 11-12 in girls. Precocious puberty causes adverse effects on the social and psychological development of the child since she or he enters teenager stage much earlier compared to his peers.

Precocious puberty is treated with medications to delay changes caused by early puberty.

Having signs of puberty at very young age are symptoms of precocious puberty:

In girls

• First menses (menarche)
• Growth of breasts and pubic hair,
• Accelerated growth, acne and adult body odor

In boys

• Growth of testicles and penis
• Appearance of facial hair
• Deepening of voice
• Appearance of pubic hair, acne and adult body odor

You need to see a doctor when your child has these symptoms for evaluation and treatment.

Problems in the brain, pituitary gland or the gonads (ovaries or testes) can cause precocious puberty.

For puberty to start, the brain first produces a hormone called gonadotropin-releasing hormone (Gn-RH), which stimulates the pituitary gland in turn to produce two hormones luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

The LH and FSH cause the ovaries (in females) and testes (in males) to develop and produce hormones testosterone and estrogen that promote and maintain sexual characteristics in men and women, such as deep voice and muscle build in men, and menses and body shape in women.

Cases of precocious puberty are classified as either central or peripheral.

Central precocious puberty

Many cases of central precocious puberty have no identifiable cause. Simply, the puberty process starts too soon and the patient usually does not have any medical problem. In this case, the brain starts to produce Gn-RH starting the puberty process too soon.

Rarely, the following causes or are associated with central precocious puberty:

• Tumor or congenital defects (like hydrocephalus) in the brain or spinal cord
• Radiation exposure, or injury to the brain or spinal cord
• Hormonal problems caused by McCune-Albright syndrome, a genetic disease that causes bone problems and adverse skin color
• Congenital adrenal hyperplasia or hypothyroidism, which is associated with precocious puberty

Peripheral precocious puberty

This is caused by problems in estrogen or testosterone. In peripheral precocious puberty, the levels of the gonadotropin-releasing hormone are normal. There is a problem that causes the release of estrogen or testosterone that makes the puberty start at a very early age.

This problem may have something to do with the following conditions affecting the ovaries, testicles, pituitary or adrenal glands:

• Presence of a tumor or cyst in ovaries (ovarian tumors or ovarian cyst) or testicles (Leydig cell or Germ cell tumor) that in itself produces estrogen or testosterone
• Having McCune-Albright syndrome
• Exposure to outside sources of estrogen or testosterone, jumpstarting puberty process. Culprits include creams, ointments, anabolic steroids and excessive exposure to Bisphenol-A
• In boys, having a rare condition called gonadotropin-independent familial sexual precocity, a genetic disorder that causes the testicles to produce testosterone as young as 1 to 4 years old

A family doctor or a pediatrician diagnoses most cases of precocious puberty. For treatment, you may be referred to another specialist called pediatric endocrinologist, which specializes in treating hormone-related problems in children.

As part of the diagnosis, the doctor may ask you questions about family medical history, particularly if any of them have risk factors like hormone-related diseases and tumors.

The doctor might also ask the starting age of puberty of family members and the family racial composition.

Before the checkup, here are things you might want to do first:

• Ask for any pre-appointment restrictions, if any. The child may have to do diet restrictions before the appointment.
• List down the child’s symptoms (including seemingly unrelated ones), medications and vitamins, and personal information such as major stresses, school or social difficulties and recent life changes.
• Information on height is important. The doctor may ask for measurements of child’s height, as well as those from family relatives.
• Check for family history of precocious puberty or hormone-related diseases such as diabetes, thyroid, and adrenal gland disorders, pituitary gland problems and conditions affecting the ovaries or testes

You might want to ask questions to your doctor

Here are some questions to give you ideas:

• What could be the causes of the condition?
• What are the needed tests for this condition?
• What are the treatment options and alternatives? What would be the best for the child?
• What could be the treatment options if my child has other health problems?
• Are there any restrictions needed during treatment?
• Do I have to see a specialist?
• Are there generic versions of the needed medicines?
• Can you share with me printed and online materials to help me understand the condition

Precocious puberty treatment focuses on addressing the cause. Fortunately, there is a treatment for central precocious puberty with no identifiable cause.

The doctor may prescribe Gn-RH analogue like leuprolide (Lupron Depot), which counteracts the effects of gonadotropin-releasing hormone and stops the progress of puberty. Gn-RH analogue is given and stopped right at the time of normal puberty age.

For precocious puberty caused by a problem such as a tumor in the gonads, the underlying problem is treated.

There is nothing you can do to avoid factors like gender or family history. However, there are things you can do to prevent chances of precocious puberty:

• Try to keep your child body weight within normal levels. Obesity is a risk factor for precocious puberty.
• Keep your child away from external sources of estrogen and testosterone. Make sure the child does not have access to testosterone patches, estrogen creams and pills, dietary supplements and anabolic steroids.

Here are the factors that increase risk of precocious puberty:

• Precocious puberty affects more females than males
• It is more common among African-Americans
• Being overweight or obese
• Exposure to outside sources of hormones such as testosterone patches and estrogen creams, dietary supplements and anabolic steroids
• Having conditions such as hypothyroidism, McCune-Albright syndrome, congenital adrenal hyperplasia
• Receiving radiation therapy for tumors or leukemia, which can expose the brain or spinal cord to radiation