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Puberty normally occurs in a series of five stages (Tanner stages) that typically begin within the ages of 8 and 13 for girls and 9 and 14 for boys. Puberty is consider early (precocious puberty) if it occurs before the age of 8 years in girls and 9 years in boys. Children who begin puberty early should have a full evaluation by their Pediatrician and will often need to see a Pediatric Endocrinologist. A prompt evaluation is necessary, because untreated, early puberty can lead to short stature in adults.
Early puberty is usually thought of as being either central precocious puberty, which can be from a tumor (more commonly in boys) of the central nervous system, including hypothalamic hamartomas, infections, head trauma, hydrocephalus, or hypothyroidism, or peripheral precocious puberty, usually secondary to McCune Albright syndrome, ovarian cysts and tumors or testicular tumors. However, most cases of early puberty, especially in girls, are idiopathic, meaning that no cause is found.
The timing of puberty is also influenced by genetics, and beginning puberty early may run in the family. Early puberty is also more common in overweight children.
Recent studies have shown that puberty is occurring at an increasingly earlier age in children.
After a complete evaluation and physical exam, if your child shows signs of precocious puberty , your Pediatrician is likely to do further testing. These tests will probably include a bone age, which is the chronological age of your child's bones. This is determined by taking an x-ray, usually of his left wrist and hand. Children with precocious puberty usually have advanced maturation of their skeleton, so while they may be only 6 years old, they may have a bone age of 8 or 9 years.
Other testing can include, but is not limited to, determining a child's blood levels of follicle stimulating hormone (FSH), leutinizing hormone (LH), and the sex hormones (testosterone in boys or estrogen in girls). Children with central precocious puberty will have a MRI of their head and girls may have a pelvic ultrasound.
It is also possible to have incomplete precocious puberty, with either early breast development (premature thelarche) or early growth of pubic hair (premature pubarche/adrenarche) and no other signs of puberty or advanced growth. These children should have a normal bone age, and if they do, your Pediatrician may just observe their growth and watch for the development of other signs of puberty before doing a further workup. Premature adrenarche can sometimes be a sign of an androgen problem, so close follup-up, especially during puberty and until menarche. Other signs of androgen excess can include hirsuitism and excessive weight gain.
Treatments of precocious puberty depend on whether or not there is an underlying cause. If there is, then that condition is treated. For children with idiopathic precocious puberty, where no underlying cause is found, then treatments are aimed at inhibiting the hormones that cause puberty with a long-acting agonist of GnRH (gonatotropin releasing hormone). GnRH is released by the hypothalamus and normally increases in pulses during puberty to stimulate the release of FSH and LH. With treatment, there should be a a regression or at least no further progression into puberty, a decrease in the rate of your child's growth and in the advancement of their bone age, and a return to prepubertal hormone levels. Treatment is usually continued until the age of 11 or 12 in girls and 12 or 13 in boys, at which time they are allowed to enter puberty.
It is important to keep in mind that not all children with precocious puberty require treatment, especially if their bone age is not very advanced and they have a normal rate of growth. They will require frequent visits to their doctor to monitor their growth and development and to see if treatment is required at a later time.
It is also important to evaluate and manage the psychological effects of beginning puberty early. Children with precocious puberty may have an advanced body and physical appearance, but their mind and emotions still correlate with their chronological age. Keep your child's real age and not how old they look in mind.
Growth Disorder Resources:
- The Magic Foundation: "Major Aspects of Growth In Children for Children's Growth and Related Adult Disorders," a nonprofit organization providing support and education regarding growth disorders in children and related adult disorders, including adult growth hormone deficiency.
- Too Soon: information about treatments for children with early puberty from the makers of Lupron.
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