Precocious puberty is a condition in which a child experiences physiological changes before the age of 8 years in girls and before the age of 9 years in boys, such as abnormally fast body growth, pubic or underarm hair growth, or early menstruation in girls.
Premature puberty is common in girls. It is a condition caused by the production of sex hormones that work prematurely. It may affect or increase the risk of complications in children in the long term, such as children may be shorter than other children of the same age when they grow up or have psychological effects such as lack of self-confidence or stress.
Symptoms of Premature Puberty
Children with precocious puberty often experience various physical changes that indicate they are entering puberty early. It occurs before the age of 8 in girls and before the age of 9 in boys. These include rapid height growth, hair growing in the pubic and underarm areas, acne, body odor similar to an adult, and other changes depending on the child’s gender, such as:
- Girls may notice larger breasts, pubic hair, acne, rapid growth, vaginal discharge, or menstrual periods.
- Boys may notice enlargement of the testicles and penis, the development of a mustache, or a cracking voice.
However, each child may have different changes as mentioned above. For example, some girls may have only menstruation but no other physical changes. If parents find that their child has the above characteristics, they should take their child to see a doctor for early diagnosis or appropriate treatment.
Causes of Premature Puberty
Premature puberty is caused by the ovaries or testes producing sex hormones before their time. This is because the brain produces gonadotropin-releasing hormone (GnRH) too early, or before the age of 8 in girls and before the age of 9 in boys. As a result, the ovaries or testes produce sex hormones before their time and have physical growth that is faster than normal.
Most often, doctors cannot find the cause of this mechanism, and it is usually not the result of another physical disorder. In some cases, the mechanism may be related to certain factors, such as:
- heredity
- Have a tumor in the brain or spinal cord
- Brain abnormalities since birth, such as hydrocephalus.
- The use of radiation therapy to treat the brain or spinal cord
- Damage to the brain or spinal cord
- Genetic disorders related to hormonal abnormalities in the body, such as McCune–Albright Syndrome or Gonadotropin–Independent Familial Sexual Precocity, which result in an increased production of testosterone in boys.
- Genetic disorders that cause the adrenal glands to produce abnormal hormones, such as Congenital Adrenal Hyperplasia.
- Hypothyroidism
In addition, premature ovarian or testicular production of sex hormones may result from causes unrelated to the brain’s production of gonadotropin-releasing hormone, such as abnormalities or tumors of the ovaries, testes, adrenal glands, pituitary glands, and the use of certain products that contain estrogen or testosterone.
However, precocious puberty is a rare condition, but it is likely or may occur more in people at risk, such as:
- Girls
- Children whose family members have a history of precocious puberty
- Children with obesity
- Children who use products such as creams, oral medications, or dietary supplements that contain estrogen or testosterone.
- Children with physical abnormalities or certain illnesses, such as McCune-Albright syndrome, Congenital Adrenal Hyperplasia, or hypothyroidism, etc.
- The child has a history of radiation therapy to the brain and spinal cord.
Diagnosis of precocious puberty
To diagnose precocious puberty, the doctor will ask about the child’s symptoms and history, including the child’s and family’s medical history. The doctor will also perform a physical examination, blood tests to check hormone levels, and X-rays of the hands and wrists to determine the age and bone growth.
If the doctor thinks that the child is likely to have precocious puberty, the doctor will measure the body’s sex hormone levels (GnRH Stimulation Test) by injecting gonadotropin releasing hormone at regular intervals to see the body’s hormonal response. The results will be used to consider additional testing methods, as follows:
- If the levels of various hormones in the child’s body are increased, it is possible that the patient’s brain produces gonadotropin-releasing hormone too quickly. The doctor may examine the patient’s brain with a magnetic resonance imaging (MRI) scan to check for abnormalities. In some cases, the doctor may also examine the thyroid gland if the child has symptoms that may be signs of hypothyroidism, such as fatigue, lethargy, feeling cold easily, constipation, learning problems, dry or pale skin.
- However, if the levels of hormones in the patient’s body are stable, it is possible that some organs of the patient are the cause. The doctor may consider appropriate tests for each patient, such as blood tests to check the levels of other hormones, or in the case of girls, the doctor may perform an ultrasound to check if the patient has cysts or tumors in the ovaries, etc.
Treatment of premature puberty
Patients with only mild symptoms or those who are nearing their normal age of development may not need treatment. Or if the doctor cannot diagnose the cause, the doctor may only observe the patient’s symptoms from time to time. In cases where other health problems are the cause of premature puberty, the doctor will treat the cause, such as:
- In patients who experience premature puberty due to tumors in their bodies, doctors may recommend surgery to remove the tumors.
- If the patient’s brain produces gonadotropin-releasing hormone too quickly, the doctor may treat with a synthetic hormone called GnRH Agonist to suppress the release of hormones from the pituitary gland. The doctor may choose an injection that must be injected every 1 month or an implant that lasts for about 1 year. The doctor will have the patient stop using the medication when the patient is close to entering normal growth, which is about 3–6 months.
Complications of Premature Adolescence
Premature puberty can cause children to be shorter as they get older because the growth plates, or areas of bone that can grow, often close or stop growing earlier than the appropriate age. As a result, children with prematurity are shorter than their age group in the long run.
In addition, precocious puberty can affect children’s mental, emotional, and social aspects because they may feel different from other children of the same age, such as feeling insecure, stressed, aggressive, easily irritated, having inappropriate sexual behavior, substance abuse, or being at risk of depression , etc.
Prevention of Premature Adolescence
Preventing premature puberty can be difficult, as some risk factors cannot be controlled. However, it can be helpful to reduce the risk by ensuring that children avoid taking or using products that contain sex hormones such as estrogen and testosterone unless under the advice of a doctor, and by helping to control a child’s weight, as certain conditions, particularly obesity, being overweight, or diabetes, can increase a child’s risk.
