While a child is going through the pubertal period, his or her body and other organs start transforming into the size of an adult. Puberty, which starts before attaining the age of 8 in girls and prior to the age of 9 in boys, is deemed to be precocious puberty.
Frequently, the reasons of precocious puberty remain untraceable. Hardly, some reasons like injuries, brain abnormalities, tumors, hormone imbalance or the presence of infections may affect the puberty and cause precocious puberty. The treatments of precocious puberty usually comprise medicines for delaying further growth.
Symptoms and signs
Symptoms and signs of precocious puberty include growth of the under-mentioned prior to attaining the age of 8 in girls and, 9 in boys.
Signs and symptoms in girls may include:
Onset of first period (menarche in medical terminology)
Signs and symptoms in boys include:
Unusual facial hair growth (normally hair grow on the upper lip initially)
Symptoms and signs that may happen in both girls and boys may include:
Underarm or pubic hair growth
Body odor found in adults
When to see a doctor
Consult your child’s physician for assessment in case your child has developed any of the symptoms and signs pertaining to precocious puberty.
Causes of precocious puberty
For understanding the reasons of precocious puberty, it is worthwhile to know the puberty process. The puberty process entails the following:
The Gn-RH creates the pituitary gland, which, in turn, releases several other hormones. The gland is located at the bottom of the brain and is shaped like a bean. The hormones released by the pituitary are Follicle-stimulating Hormone (FSH) and Luteinizing Hormone (LH).
Both FSH and LH send messages to the ovaries to generate estrogen hormone concerned with the development and growth of a woman’s sexual involved in the growth and development of female sexual individuality and the testicles to generate testosterone hormone accountable for the development and growth of a man’s sexual distinctiveness.
Why this developmental process starts early in certain children depends on the two types of precocious puberty:
- Central Precocious puberty; and
- Peripheral puberty.
Central precocious puberty
There is normally no particular reason for this kind of precocious puberty.
In the case of central precocious puberty, the process of puberty begins too early. The pattern and timing of the steps in the puberty process are otherwise normal. For a majority of children having this condition, there is no fundamental medical issue and no particular reason for the onset of early puberty.
In several rare cases, the under-mentioned conditions may be the reason of central precocious puberty:
A spinal or brain tumor (both controlling the central nervous system)
A birth defect, like hamartoma ( a non-cancerous tumor) or hydrocephalus (excessive fluid buildup)
Spinal cord or brain exposure to radiations
Spinal cord or a brain injury
Albright syndrome (McCune Albright Syndrome) is a genetic ailment that happens rarely affecting the skin color and bones also causes hormonal issues.
The presence of CAH (Congenital adrenal hyperplasia). It is a set of genetic abnormalities wherein adrenal glands generate unusual hormones.
Hypothyroidism condition – the thyroid gland’s inability to generate adequate hormones.
Peripheral precocious puberty
In peripheral precocious puberty condition, the testosterone and estrogen may cause this kind of precocious puberty in your child.
The peripheral precocious puberty, which is not so common, happens without involving the brain hormone (Gn-RH), which usually activates the beginning of puberty. In place of it, the reason is testosterone and estrogen discharge into the body due to issues with the pituitary gland, adrenal gland, testicles and ovaries.
Both in boys and girls, the peripheral precocious puberty may happen because of the following:
A pituitary or the adrenal gland tumor; both of them generate testosterone and estrogen.
The presence of Albright or the McCune-Albright syndrome: It is a genetic abnormality that happens rarely, but harms the bones and skin color, besides creating hormonal issues.
Contact with exterior resources of testosterone and estrogen, like ointments and creams.
Among girls, the peripheral precocious puberty may be linked with:
Cysts or tumors in the ovaries
Among boys, the peripheral precocious puberty may occur because of:
A tumor in the Leydig cells that generate testosterone hormone and the sperm cells.
Gene mutation — it is a rare abnormality known as gonadotropin-independent genetic sexual precocity, which happens owing to a deficiency in a gene and cause the premature generation of the testosterone in boys, normally when they are 1 to 4 years of age.
Factors that contribute to a child’s risk of precocious puberty comprise:
The girls are much more prone to developing precocious puberty.
The precocious puberty seems to be affecting African-Americans more than the infants from other races.
Children, who happen to be considerably overweight (obese), have an increased risk of precocious puberty.
Exposure to testosterone and estrogen ointments and creams and other material having these hormones, like an adult medicine or his or her dietary supplements, may contribute to your child’s risks of precocious puberty.
Precocious puberty may arise because of the obstacles caused by congenital adrenal hyperplasia or McCune-Albright Syndrome (also known as Albright Syndrome). In both the conditions, there is a generation of androgens (male hormones). Although rare, the precocious puberty has been, at times, linked to the Hypothyroidism.
Having undergone radiation therapy to the central nervous system: Radiation treatments for leukemia, tumors and other medical conditions may contribute to the precocious puberty risk.
Probable obstacles of precocious puberty may include:
Less height. Children having precocious puberty may mature rapidly initially and become tall, compared to other children of their age. As their bones grow more rapidly than the usual speed, they normally stop gaining maturity sooner than the usual. This way, they remain shorter than standard as adults.
Precocious puberty, if treated at the early stage, mainly when it happens in young children, may help them mature taller than they will without any treatment.
Emotional and social issues. Boys and girls, in whom puberty begins prior to the children of their age group, may become particularly self-conscious about the growth happening in their body size and shape. This may harm their self-esteem, which, in turn, increases the risk of developing depression and, at times, substance abuse.
For diagnosing precocious puberty, your doctor may:
Evaluate the concerned child and his family’s medical history.
Perform a physical examination
Carry out blood examinations for measuring the hormonal levels
X-rays of the concerned child’s wrist and hand are also vital to diagnose the precocious puberty. With these X-rays, the doctor may ascertain the child’s bone age, which reveals in case the bones are developing too rapidly.
Ascertaining the kind of precocious puberty
Your doctor may like to know which kind of precocious puberty your child may have. For ascertaining this, she or he may perform an examination known as Gn-RH (Gonadotropin-releasing Hormone Stimulation examination. For doing so, a blood sample is required. Among children, having central precocious puberty, Gn-Rh may cause increased levels of other hormones. Among children having peripheral precocious puberty, the levels of other hormones remain the same.
Extra examinations of central precocious puberty
MRI (Magnetic resonance imaging)
An MRI of the brain is generally performed on children, who are suspected of having central precocious puberty. This helps the doctor to ascertain if any brain irregularities are causing the puberty too soon.
The treating doctor may also like examining thyroid of your child to know the indications of slow thyroid functioning. The condition is known as Hypothyroidism, wherein the child may be experiencing constipation, fatigue, sluggishness, higher sensitivity to cold, a decline in his or her learning in school, dry or pale skin.
Extra Examinations for peripheral precocious puberty
Some other examinations are also required for children having peripheral precocious puberty. They help in diagnosing the reason of this condition. For instance, the doctor may perform extra blood examinations for ascertaining the levels of other hormones. Or, in girls, the doctor may perform an ultrasound to know the presence of ovarian tumor or cysts.
The precocious puberty treatment depends on the reason of this condition. The most important objective of the treatment is to facilitate the growth of the child and his or her height equivalent to a standard adult.
Central precocious puberty Treatment
Most of the children having central precocious puberty, wherein there is no fundamental medical condition are treated successfully with medications like Analogue Therapy of Gn-RH. This therapy is executed by giving a monthly injection of the medicine, like Lupron Depot (Leuprolide) that helps in delaying the further growth of the child. Certain fresher procreations may also be administered at longer intervals.
The child is given the medicine continuously till she or he attains the usual puberty age. On an average, nearly 16 months after stopping the medicine, the puberty process starts again.
Treatment of a fundamental medical condition
If for some other medical reasons your child is confronted with precocious puberty, treating that condition becomes important for stopping the puberty progress. For instance, if the child concerned has developed a tumor, which is generating hormones and becoming the reason of precocious puberty, puberty growth generally stops if the tumor is removed by performing the operation.
Preparing for the appointment
You may look for your child’s treatment by a family physician or the pediatrician. Or, the child may be referred to a hormone specialist (pediatric endocrinologist).
Given below is the information that may help you in preparing you for your appointment and what you should be expecting from your child’s doctor.
What you may require to do
You should be aware of any pre-appointment limitations. While fixing the appointment, you may ask in case there is something you require making, like restricting your child’s diet.
Jot down your child’s signs and symptoms, including those that appear unrelated to the cause for which you are scheduling your appointment.
Make a list of important personal information, including any main stresses or lifestyle changes your child made recently.
Prepare a list of all medicines, supplements or vitamins that your child is taking and others at your home. This information is vital as your child may have exposure to them.
Also, prepare a list of heights of your family members, particularly in case anyone has remained a short-heighted as an adult.
Describe medical history of your family and make a particular mention of the members who went through issues in their endocrine system or the precocious puberty.
Carry a copy of the growth curve record of your child in case you are going to meet a new doctor, who is not aware of your child’s medical history.
Pen down questions for your child’s doctor
In order to make the appointment fruitful, pen down queries for your child’s doctor. Some fundamental queries relating to precocious puberty, you may inquire from your doctor comprise:
- What are the probable reasons of my child’s condition and symptoms?
- Could there be some other probable reasons for my child’s condition and symptoms?
- What are the examinations my child requires to undergo?
- Is my child’s condition chronic or temporary?
- What is the most effective treatment?
- When to begin the treatment and for how long?
- What are the options for the major approach you are recommending?
- My child has some other health issues. How do we best manage them together?
- What are the restrictions my child requires to follow?
- Do we also consult a specialist for my child?
- A standard option to the prescribed medicine?
- Any website you suggest me?
- Are there printed material or brochures, I should carry at home to read?
Feel free to anything else you may have in mind
What to anticipate from your doctor
Most likely, your doctor may have a few questions about:
- Medical history of your family, especially height of each member of your family and the record of tumors, endocrine abnormalities, if any
- The age when puberty started for your parents and siblings
- Racial composition of your family
- How to support your child’s coping with the condition?
Children, experiencing precocious puberty, may see themselves different from other children in their age group. There is a possibility that seeing themselves different from other children may cause emotional and social issues, even indulging in unnatural sex. You, as a parent, may also face difficulties dealing with your child’s development sooner than your expectations.
In case your child, you or any other family members are facing difficulty in coping, you are advised to seek counseling. Emotional counseling may help your child and your family in your better understanding and help you in handling the challenges, emotions and issues related to precocious puberty. You may seek the help of your health care provider in finding a competent counselor.
Certain risk factors related to precocious puberty like your race and sex is inevitable. But, there are many things that may help you in decreasing the probability of precocious puberty, such as:
- Keep your child away from exterior exposure to testosterone and estrogen, like dietary supplements and prescribed medicines in your house having testosterone and estrogen.
- Encourage your child for maintaining a balanced and healthy weight