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Precocious Puberty

Alternate Names

  • sexual precocity

Definition

Puberty is a time when body changes occur that produce adult sexual characteristics in both the male and the female. Following puberty, the individual is able to reproduce for the first time. Precocious puberty is a condition in which these changes occur at an earlier age than normal.

What is going on in the body?

Hormones are released during puberty that foster physical growth and sexual development. The primary sexual changes that occur during puberty are the growth and maturation of the ovaries in girls and the growth and maturation of the testicles in boys.
The secondary changes include the following:
  • the appearance of pubic and underarm hair, as well as facial hair in boys
  • increase in muscle mass and strength in boys
  • a rapid increase in height and weight
  • widening of the pelvis and breast development in girls
Precocious puberty can occur when the sexual hormones are released early without another precipitating cause. This is known as CPP, or central precocious puberty. With CPP, sexual changes occur in the normal order seen in puberty.
PPP, or peripheral precocious puberty, occurs when other conditions trigger the early production and release of sexual hormones. With PPP, sexual changes may not occur in the normal order seen in puberty. Partial forms of precocious puberty are relatively common. Girls may develop breasts prematurely without other changes. Boys or girls may have sexual hair early, without other changes.

Risks

What are the causes and risks of the condition?

No underlying cause of precocious puberty can be found in 85% of girls and 40% of boys. For the remaining children, causes may include:
  • certain brain infections
  • cranial radiation, where the brain is exposed to X-rays
  • epilepsy, a central nervous system disorder causing seizures
  • fetal alcohol syndrome, which may occur if the mother drinks alcohol during her pregnancy
  • hydrocephalus, a condition in which there is extra spinal fluid in the brain
  • hypothyroidism, or an underactive thyroid gland
  • severe head injury
  • tumors of the ovaries, testicles, or other organs
  • structural defects or tumors in the brain

Precocious puberty can also be inherited. In a family where one parent carries the gene, there is a 50% percent chance that male infants would be affected. Female infants would have a 50% chance of being a carrier for the gene.

Estrogens from outside the body can cause premature sexual changes, like breast development, that can look like precocious puberty. These precocious changes go away after the estrogen exposure is stopped. Estrogens are found in the following:
  • certain meats, like poultry
  • cosmetics
  • hair and body creams
  • oral contraceptives
  • some vitamins

Prevention

What can be done to prevent the condition?

Most forms of precocious puberty cannot be prevented.

Diagnosed

How is the condition diagnosed?

Diagnosis of precocious puberty begins with a medical history and physical exam. The healthcare professional may order tests, including:
  • blood tests to check hormone levels
  • CT and MRI scans of body tissues
  • ultrasound
  • X-rays of the bones
Other tests may be ordered to verify suspected underlying disorders.

Long Term Effects

What are the long-term effects of the condition?

Some forms of precocious puberty cause the skeleton to mature quickly. At first, these children are taller than their peers. However, growth stops early for these children. Without treatment, they may end up being very short adults. Other long-term effects depend on the underlying conditions identified.

Other Risks

What are the risks to others?

Precocious puberty is not contagious and poses no risk to others.

Treatments

What are the treatments for the condition?

Children with CPP may be treated if their bone age is 2 years more advanced than their chronological age. Injections of long-acting GnRH agonists, such as histrelin, can be given. These injections cause sexual development to stop. The normal growth rate returns. Girls can be given this treatment until they are between 11 and 12 years old. Boys can be given this treatment until they are between 12 and 13 years old.
Children who have precocious puberty for reasons other than CPP need to have the primary disorder treated. This can include:
  • cortisol to treat adrenal gland disorders
  • removal of a tumor
  • thyroid hormone replacement for those with hypothyroidism

Side Effects

What are the side effects of the treatments?

Some girls with CPP will have vaginal bleeding about 2 weeks after the first injection of a GnRH agonist. This bleeding usually does not recur.

After Treatment

What happens after treatment for the condition?

Because their growth and sexual development is advanced, some children with precocious puberty may feel isolated from their peer group. Frank and early discussion about their condition and body image may be reassuring. Parents and other concerned adults should be alert to signs that the child is having difficulty coping.

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

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