PRECOCIOUS OR PREMATURE PUBERTY

When an individual matures both emotionally and physically and becomes an adult capable of reproduction through the natural development of the reproductive organs, it is expressed as puberty. It happens in stages, both in boys and girls. The age when it happens depends on race, nutrition and

genetics . The normal age of maturation in a girl is about 10 -11 years, in boys it is 9 to 12 years. The girls have their first period about the age of 11. This is called menarche.

To start with if your child is 6 years of age or younger and shows development of breast buds, growth spurt, axillary hair, problems at school and if she has a period; you have to be worried, this is surely precocious puberty.  Please tell your child honestly what is going on. Tell her this is normal as you grow older but for some reason your body has started developing earlier.

The good news is that these children can be treated. To understand what causes premature maturation let us revise what starts maturation in the first place. In the brain (The Hypothalamus) starts the process, how we do not know. The brain secrets a hormone called Gonadotropin- releasing hormone (GnRH). This acts on our main endocrine gland which is the pituitary gland located in the brain, which in turn realeases two more hormones, follicle – stimulating hormone (FSH) and luteinizing hormone (LH). These act on the ovaries in the female, producing oestrogens and small amounts of testosterone. In boys they act on the testicles producing testosterone. The oestrogens and testosterone cause puberty changes in boys and girls. In girls testosterones helps with the growth of axillary and pubic hair. The hormone called LH is involved with ovulation.

When this maturation occurs at a very young age it is called Precocious Puberty. Puberty can also be delayed causing anxiety again. We will discuss this in another blog.

These early developmental changes when they arise in the brain, are called central precocious puberty. This can also happen due to brain tumours, infections of the brain, too much fluid in the brain (Hydrocephalous), radiation to the brainThere are peripheral problems (outside the brain) which can cause precocious puberty. . Congenital problems and congenital adrenal hyperplasia. McCunes – Albright syndrome, is also a congenital disorder which causes hormone problems and finally an under active thyroid gland can also cause precocious puberty

These can be due to tumours of the adrenal glands, ovarian cysts and ovarian tumours.

  

WHAT ARE THE RISK FACTORS

Girls of African American origin, obese girls and exposure to hormones which can be used for treatment of other medical conditions and radiation for tumours or leukemia.

COMPLICATIONS

Initially they grow taller than their age, then they stop once they achieve puberty; because their bones stop growing earlier than usual. Treatment started early will help them to grow taller. The girls whose bodies are changing become very self conscious withdrawn and depressed.

DIAGNOSIS

You must take your child to a Paediatrician or a Paediatric endocrinologist.  They will study your family medical history, the child’s history and do a general examination. They will also do blood tests, mainly hormones, including Thyroid, ultrasound of the Ovaries. X-ray of bones to assess the bone age and magnetic resonance of the brain to see if there are any brain conditions. These tests will help them to know if the precious puberty is of peripheral or central origin.

TREATMENT

The child if of an understanding age, should be explained what is going on. Reassured and praised where possible, such as any achievement in sport, school which will help to build self confidence. Generally no treatment is offered if the child is about 8 years of age. For precocity of central origin GnRH   analogue therapy is offered, named LEUOPROLIDE as an injection once a month until the age of puberty. It suppresses the GnRH activity. 16 months after the treatment is stopped maturation starts again.

Any other peripheral diseases are treated as well, such as an under active thyroid or any tumours, which are removed. This   analysis does not cover precocious puberty in boys.

SUMMERY

Precocious Puberty is when a child’s body develops like an adult at a very young age. It is a very rare condition and occurs once in 5000 children, but once it happens it is frightening. Do not panic.  It is easily diagnosed and treated.

Puberty includes rapid growth of bones muscles and genitals, body shape and size changes and it can reproduce. The cause of this precocious development is often not understood. Sometimes infections, injuries, tumours, brain abnormalities and radiation cause these problems. The treatment includes stopping   any further maturation.