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Precocious puberty

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Precocious puberty

  1. 1. Precocious puberty DEFINTION :-Precocious puberty is when a child's bodybegins changing into that of an adult (puberty) too soon. When puberty begins before age 8 in girls and before age 9 in boys, it is considered precocious puberty. TYPES  There are two types of precocious puberty: central precocious puberty is the morecommontype. Theprocessis identical to normalpuberty, buthappensearly. Thepituitary gland is prompted to producehormones, called gonadotropins. Thesehormonesin turn stimulate the testicles orovaries to make otherhormones, testosteroneorestrogen. It's thesesexhormones thatcausethechanges ofpuberty,like breastdevelopment in girls.  Peripheralprecociouspuberty orprecociouspseudo-pubertyis a different condition. It'salso rarer. Thehormones estrogenand testosteronetriggerthe symptoms.Butthe brain and pituitary gland are notinvolved. It's usually a local problemwith the ovaries, testicles,adrenalgland, ora severely underactivethyroid gland. RISK FACTORS Factors that increase a child's risk of precocious puberty include:  Being a girl. Girls are much more likely to develop precocious puberty.  Being African-American. Precocious puberty appears to affect African- Americans more often than children of other races.  Being obese. Children who are significantly overweight have a higher risk of developing precocious puberty.  Being exposedto sexhormones. Coming in contact with an estrogen or testosterone cream or ointment, or other substances that contain these hormones (such as an adult's medication or dietary supplements), can increase child's risk of developing precocious puberty.  Having other medical conditions. Precocious puberty may be a complication of McCune-Albright syndrome or congenital adrenal hyperplasia — conditions that involve abnormal production of the male
  2. 2. hormones (androgens). In rare cases, precocious puberty may also be associated with hypothyroidism.  Having receivedradiation therapy of the central nervous system. Radiation treatment for tumors, leukemia or other conditions can increase the risk of precocious puberty. CAUSES CENTRALPRECOCIOUS PUBERTY In girls, the cause of precocious puberty 90 to 95 percent of the time is idiopathic, or unknown, Boys are more likely to have an underlying identifiable cause. Early puberty and sexual development may be caused by:  central nervous system abnormalities  family history of the disorder  certain rare genetic syndromes  tumors of the pituitary gland or brain CAUSES PERIPHERALPRECOCIOUS PUBERTY Peripheral precocious puberty may be caused by:  certain rare genetic syndromes  tumors of the ovary or testis  other tumors that secrete human chorionic gonadotropin  disorders of the adrenal gland  severe hypothyroidism CLINICAL FEATURES:- Girls:  Increasing height/growth spurt  Breast development  Menstruation or vaginal bleeding Boys:  Enlarging testicles and penis  Pubic and underarm hair  Facial hair  Spontaneous erections and/or ejaculations
  3. 3.  Development of acne  Deepening of the voice COMPLICATIONS Short height. Social and emotional problems. DIAGNOSIS AND MANAGEMENT Initial evaluation will include History:- including the onset of symptoms, rate of progression, growth and family history of PP and diabetes mellitus. Physicalexamination should include anthropometry and pubertal staging. Endocrine evaluation should include measurement of LH, FSH, E2 gnrh stimulation test, Pelvic ultrasound for ovaries and uterus. Additional investigations may include measurement of 17 Hydroxyprogesterone (17OHP), DHEAS, Plasma Insulin,Ovaries are asymmetrically enlarged in PPP. Cranial magnetic resonance imaging (MRI) should be done in cases of CPP to exclude CNS pathology. X-rays, usually ofthe hand and wrist, to checka child's boneage;this is a way ofseeing how quickly he orshe is growing, and if final adult height might be impacted. Treatment EarlyPuberty:TreatmentOptions centralprecociouspuberty,medicationscalled GnRHanalogs arethe standard treatment. They workbyblockingthe hormones comingfromthe pituitary gland that trigger puberty.  Injectionsaregiven as monthly shotsinto muscles ordaily shots givenjust underthe skin.
  4. 4.  Implants aretiny tubes -- a little overan inch long -- that are placed underthe skin, usually in the upperarm. Theygradually release medicine into the body.  Nasalspraysaregiven daily.  Progestin.Injections ofprogestinused to bethestandard treatmentforcentral precociouspuberty.Theyareless effectivethan GnRHanalogs.  Othertreatments.Surgeryand radiationmight benecessaryin caseswhere centralprecociouspubertyhas beentriggered bya brain tumor. Removingthe tumorwon'talways resolveall the symptoms. TREATING PERIPHERALPRECOCIOUSPUBERTY Treatment for peripheral precocious puberty depends on what’s causing excess estrogen or androgen production. Options include Tumor removal, Blocking the actions of estrogen or androgen on the body, Or treatment of hypothyroidism with replacement thyroid hormone.