• Precocious Sexual Development

    (Precocious Puberty; Premature Puberty)

    Definition

    Girls enter puberty between the ages of 8-14. Boys enter this stage between the ages of 9-14. Sometimes the physical changes may happen earlier. This is called precocious sexual development or premature puberty.
    For girls, this means that before the age of eight they may:
    • Develop breasts
    • Have armpit or pubic hair
    • Have mature sex organs
    • Experience their first period
    For boys, this means before the age of nine they may have:
    • Enlarged sex organs
    • Armpit, pubic, or facial hair

    Causes

    In about 25%-75% of affected boys, this condition is due to an underlying medical conditions. However, for many girls and some boys there is no known cause.
    Some known causes of premature sexual development include:
    Pituitary Gland
    Pituitary
    Copyright © Nucleus Medical Media, Inc.
    Causes specific to girls:
    • Having ovarian tumor or cysts
    • Taking estrogen
    Causes specific to boys:
    • Having tumors on the testicles
    • Taking male sex hormones (androgens)
    Other causes:

    Risk Factors

    Factors that increase the risk of precocious puberty include:
    • Sex: girls are 2 to 5 times more likely to experience premature puberty than boys
    • Family history—some cases may run in families
    • Taking sex hormones
    • Head injury
    • Radiation of head
    • Infection in brain
    • Some studies have suggested a link between obesity and premature puberty

    Symptoms

    One symptom common to both boys and girls is a premature growth spurt in height. Children with this condition may be taller than their peers. As an adult, they may be shorter. The rapid growth also makes their bones stop growing sooner than normal. Other symptoms include:
      In girls, early arrival of:
      • Breast development
      • Pubic hair
      • Armpit hair
      • Onset of period
      • Ovary enlargement
      • Cysts on ovaries
      In boys, early arrival of:
      • Facial hair
      • Armpit hair
      • Pubic hair
      • Penis growth
      • Increased masculinity
      • Testicle enlargement
      In both girls and boys, early arrival of:
      • Body odor
      • Acne
      • Behavior changes
      • Growth spurt

    Diagnosis

    The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. An assessment of puberty milestones and growth will be done. An x-ray of the left wrist bone may also be taken. This will help to assess if the bone growth is normal for your child’s age.
    Depending on these results, other tests may be ordered, including:
    • Adrenal and pelvic ultrasound —images of kidneys and sexual organs created by sound waves
    • Testicular ultrasound if testicular enlargement is uneven
    • MRI of the brain—detailed images of the brain
    • Blood tests to measure the levels of hormones such as:
      • In girls: follicle-stimulating hormone (FSH), luteinizing hormone (LH)
      • In boys: testosterone
      • Human chorionic gonadotropin (hCG) levels—hormone that affects growth
      • Thyroid hormone levels—if hypothyroidism suspected
      • Growth hormone-releasing hormone (GHRH) stimulation test
      • Dehydroepiandrosterone (DHEA) levels—early form of sex hormones

    Treatment

    The treatment depends upon the cause.
    If the bone age is about the same as the child's actual age and there is no known cause, there is no treatment. The child will continue to be monitored. Psychological support may be recommended if a child is struggling.
    Other children may require treatment. This may include medication or surgery.

    Medications

    Medication is often used in children whose bone age is older than their actual age. These medications stop or slow sexual development. They also halt the rapid bone growth and encourage normal growth.
    These medications called hormone suppressors may include:
    • Leuprolide acetate
    • Histrelin
    • Nafarelin
    Metformin has also been shown to be effective in delaying puberty.

    Psychological Support

    Developing before their peers may cause social challenges in some children. Psychological support may be helpful. Talk to your child's doctor about what options are available.

    Surgery

    Surgery may be needed if the early puberty is caused by a tumor or other lesions. The procedure will depend on the location and size of the tumor.

    Ongoing Monitoring

    The doctor will continue to check your child’s height, weight, and sexual development. This will help to note any changes or show if the treatment has been effective.

    Prevention

    Most precocious development cannot be prevented. To help reduce the chance, make sure your child is kept as healthy as possible. This includes making sure they are eating well and getting all the nutrients they need. Help your child maintain a healthy weight. Avoid exposure to sex hormones.

    RESOURCES

    The American Academy of Family Physicians http://www.familydoctor.org/

    American Academy of Pediatrics http://www.healthychildren.org/

    CANADIAN RESOURCES

    Caring for Kids http://www.caringforkids.cps.ca/

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

    References

    Blondell RD, Foster MB, Kamlesh CD. Disorders of puberty. American Family Physician website. Available at: http://www.aafp.org/afp/990700ap/209.html . Accessed August 15, 2012.

    Cesario SK, Hughes LA. Precocious puberty: a comprehensive review of literature. J Ob Gyn Neonatal Nurs. 2007;36:263-274

    DynaMed Editorial Team. Precocious puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated March 15, 2012. Accessed August 15, 2012.

    Himes JH, Obarzanek E, Baranowski T, et al. Early sexual maturation, body composition, and obesity in African-American girls. Obesity Research . 2004;12:64S-72S.

    Ibanez L, Valls C, Ong K, et al. Metformin therapy during puberty delays menarche, prolongs pubertal growth, and augments adult height: a randomized study in low birth weight girls with early-normal onset of puberty. J Clin Endocrinol Metab . 2006;91:2068-2073.

    Papathanasiou A, Hadjiathanasiou C. Precocious puberty. Ped Endocr Rev . 2006;3:182-187.

    Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics . 2002;110:903-910.

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