Medication
Progestin. Injections of progestin used to be the standard treatment for central precocious puberty. They are less effective than GnRH analogs. Other treatments. Surgery and radiation might be necessary in cases where central precocious puberty has been triggered by a brain tumor. Removing the tumor won't always resolve all the symptoms.
Procedures
Puberty is considered precocious when it starts, on average, in girls younger than 8 and boys younger than 9. Estimates vary, but some experts say that early puberty affects about 1 out of 5,000 children, with a predominance in females. It has been noted over the years that the age of onset of puberty varies with ethnicity.
What is the best treatment for precocious puberty?
Radiation treatment for tumors, leukemia or other conditions can increase the risk of precocious puberty. Precocious puberty signs and symptoms include development of the following before age 8 in girls and before age 9 in boys. Precocious puberty classifies into two major categories based on the etiology
What age is precocious puberty?
Knowing why we treat idiopathic precocious puberty is integral to understanding the questions of whom should we treat. The only long-term complication of true idiopathic precocious puberty is compromised adult height. Adult height is improved with treatment (2, 3).
What increases the risk of precocious puberty?
Why do we treat idiopathic precocious puberty?
Is treatment necessary for precocious puberty?
Treatment for precocious puberty depends on the cause. However, in some cases, there is no identifiable cause for precocious puberty. In this instance, your child may not need treatment depending on his or her age and how rapidly puberty is progressing.
Does precocious puberty stunt growth?
Since precocious puberty ends earlier than normal puberty, these kids stop growing at an earlier age. The result may be a shorter height than they would have otherwise had. Behavior problems. Some studies have found a link between early puberty and behavior problems, particularly in kids with developmental delays.
How can I slow down precocious puberty naturally?
Slowing down childhood obesity and early puberty with exercise and nutritionGo to the doctor. Seek advise from your child's pediatrician. ... Exercise, exercise, exercise! ... Beware of hormones in your food. ... Eat organic fruits and vegetables. ... Bake better. ... Be aware of the products you use. ... Drink plenty of water.
What will happen if precocious puberty is not treated?
Without treatment, your child might be shorter than normal as an adult. The younger your child, the more likely they are to benefit from treatment. Girls with CPP who are age 6 or older might not need it. Even younger kids may not need treatment if their body and bones grow slowly.
Does early puberty mean you will be short?
Children with precocious puberty may grow quickly at first and be tall, compared with their peers. But, because their bones mature more quickly than normal, they often stop growing earlier than usual. This can cause them to be shorter than average as adults.
Can precocious puberty be reversed?
The goal of treatment for is to stop the onset of early puberty signs. In some cases, the signs can be reversed. Treatment may include medicines that block the action of the sex hormones. If a tumor is causing the problem, surgery may be needed to remove the tumor.
What foods prevent early puberty?
Children with lower-nutrient diets tend to enter puberty earlier. A diet rich in processed foods and meats, dairy, and fast food is disruptive to normal physical development. Exposure to EDCs (endocrine-disrupting chemicals).
Why is my daughter developing so early?
For most children, early puberty starts for no known reason. It can run in families. Sometimes there is a problem in the brain, such as an injury, a tumor or an infection. Early puberty can also be caused by a problem in the sex glands (testes or ovaries), the thyroid gland or the adrenal glands.
What foods help puberty?
Protein-rich foods include lean meat, fish, chicken, eggs, beans, lentils, chickpeas, tofu and nuts. These foods are important for your child's growth and muscle development, especially during puberty.
Is precocious puberty genetic?
The most common known genetic cause of central precocious puberty is mutations in the MKRN3 gene. Changes in other genes are rare causes of the condition, and researchers suspect that changes in genes that have not yet been identified may also be involved in central precocious puberty.
Does milk cause early puberty?
Fact: There is no scientific evidence that drinking milk causes early puberty. In the United States, girls are entering puberty at younger ages than they were in the first half of the 20th century.
When do you stop Lupron for precocious puberty?
Interventions: Lupron Depot was administered as a single monthly subcutaneous injection to each patient. Treatment was usually discontinued by 10 to 11 years of age, at which time pubertal progression was allowed to resume.
What is the treatment for central precocious puberty?
This treatment, called GnRH analogue therapy, usually includes a monthly injection of a medication, such as leuprolide acetate (Lupron Depot), or triptorelin (Trelstar, Triptodur Kit), which delays further development. Some newer formulations can be given at longer intervals.
What is the best test for puberty?
Magnetic resonance imaging (MRI). A brain MRI is usually done for children who have central precocious puberty to see if any brain abnormalities are causing the early start of puberty. Thyroid testing.
What hormone is used to test for precocious puberty?
In this test, the doctor will take a blood sample, and then give your child a shot containing the GnRH hormone. More blood samples are then taken over a certain period of time to check how hormones in your child's body react. In children with central precocious puberty, the GnRH hormone will cause other hormone levels to rise.
What test is used to determine if a child is precocious?
To do so, he or she will perform a test called a gonadotropin-releasing hormone (GnRH) stimulation test.
How long does it take for a child to stop taking a syringe?
The child continues to receive this medication until he or she reaches the normal age of puberty. On average, 16 months after he or she stops receiving the medication, the process of puberty begins again.
How long should a child be monitored for puberty?
Your child's doctor may want to monitor your child for several months to see how he or she is developing.
What to do if your child is having difficulty coping?
If you, your child or other members of your family are having difficulty coping, seek counseling. Psychological counseling can help your family better understand and handle the emotions, issues and challenges that accompany precocious puberty.
What is the average age for pubertal growth?
The mean age at onset of pubertal growth development, when available, is quite variable, ranging from 2.9 to 6.5 years. This reflects the tendency to consider for treatment girls with ages of onset of puberty just below 8 years, the age range that is now considered ‘borderline’, in particular in the USA.
What is precocious puberty?
Precocious puberty results mostly from the precocious activation of the gonadotropic axis. Although the age limits have recently been discussed, most physicians consider that onset of pubertal development before the age of 8 years in a girl or 9 years in a boy warrants at least a clinical and bone age evaluation by a paediatric endocrinologist. The major concern in precocious puberty is the underlying condition, and central nervous system or gonadal neoplasm have to be formally excluded as a first step in the diagnosis. A secondary concern is height, since precocious puberty leads to accelerated growth, accelerated bone maturation and ultimately reduced stature. Precocious puberty is heterogeneous and strict criteria should be used to define it, both in terms of age and in terms of potential for progression. Depot forms of GnRH agonists are now the standard treatment for progressive central precocious puberty and aim at alleviating the clinical symptoms of early pubertal development, their psychological consequences and the effects on growth. Here, we review the consequences of both central and gonadotropin‐independent precocious puberty on adult stature and the information available on outcomes using the therapeutic regimens currently available. In girls with progressive precocious puberty, all published evidence indicates a gain of adult height over height predicted before treatment or over untreated historical controls. However, the apparent height gain (derived from the comparison of predicted and actual heights) is very variable, in large part due to the inaccuracy of height prediction methods. In girls with onset of puberty at the lower half of the normal age (8–10 years) distribution, trials using GnRH agonists have given negative results (no benefit of treatment). In boys, precocious puberty is rare and fewer results are available but point in the same direction. The most appropriate time for interrupting the treatment is still controversial. In conclusion, GnRH agonists restore adult height in children when it is compromised by precocious puberty.
How does GNRH affect pubertal development?
GnRH agonists suppress the gonadotropic axis and block pubertal development in children with central precocious puberty. These treatments are mainly aimed at relieving the psychological consequences of precocious pubertal development. Their profile of tolerance, not reviewed here, is good, although concerns have been raised regarding bone mass and body composition. In progressive precocious puberty, all published evidence indicates a gain in adult height in both sexes. However, the apparent height gain is very variable, in part due to the inaccuracy of height prediction methods. Other factors include the delay in initiating the treatment and possibly variations in the efficacy or duration of treatment. This stresses the importance of rapid referral of children with early signs of puberty. Although direct evidence is lacking, it is reasonable to believe that the effect on height varies with the age of onset of pubertal development, those presenting very early (before 4 or 5 years) being at high risk of short stature, while precocious puberty has more limited effects on height of those presenting close to the limit of normal. In contrast, in children with normal or ‘early’ puberty, GnRH agonists are completely ineffective when used for short periods. When used for an extended period in this situation, their efficacy is quite moderate with potentially severe side‐effects. The combination of GH and GnRH agonists should be viewed as experimental at this point.
What causes CPP in girls?
These neurogenic causes represent ∼20% of cases in girls and 65% of cases in boys.
Is precocious puberty heterogeneous?
A secondary concern is height, since precocious puberty leads to accelerated growth, accelerated bone maturation and ultimately reduced stature. Precocious puberty is heterogeneous and strict criteria should be used to define it, both in terms of age and in terms of potential for progression.
Is precocious puberty rare?
In girls with onset of puberty at the lower half of the normal age (8–10 years) distribution, trials using GnRH agonists have given negative results (no benefit of treatment). In boys, precocious puberty is rare and fewer results are available but point in the same direction.
What is the best treatment for precocious puberty?
The optimal treatment for familial male-limited precocious puberty is not well established, but the preferred treatment is a combination of an androgen antagonist (spironolactone) and an aromatase inhibitor (anastrozole, testolactone).
What is precocious puberty?
Precocious puberty refers to the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal. For many years, puberty was considered precocious in girls younger than 8 years; however, recent studies indicate that signs of early puberty (breasts and pubic hair) are often present in girls (particularly black girls) aged 6-8 years. For boys, onset of puberty before age 9 years is considered precocious.
What causes precocious puberty in girls?
In boys, peripheral precocious puberty may also be caused by: A tumor in the cells that make sperm (germ cells) or in the cells that make testosterone (Leydig cells).
How many women have precocious puberty?
The first epidemiologic study from a Danish national registry estimated that 0.2 % of females had some form of precocious puberty (CPP, PPP or benign variants) while it was less than 0.05% in males.
What hormones are produced during precocious puberty?
The brain starts the process with the production of a hormone called gonadotropin-releasing hormone (GnRH).
What is the result of the activation of the hypothalamic-pituitary-gonadal (
Puberty results from the activation and maturation of the hypothalamic-pituitary-gonadal (HPG) axis. At birth, there is a brief activation of the HPG axis that results in the increased production of steroidal hormones. This activation may result in breast development in females and pubic hair in males.
Which hormone is responsible for the growth and development of male sexual characteristics?
Estrogen is involved in the growth and development of female sexual characteristics. Testosterone is responsible for the growth and development of male sexual characteristics. Why this process begins early in some children depends on whether they have central precocious puberty or peripheral precocious puberty.
What is the treatment for precocious puberty?
Standard treatment of precocious puberty involves suppression of this axis with GnRH agonists ( 2 ). When precocious puberty is not idiopathic, treatment is based first on treating the underlying problem, and then may also involve treatment with GnRH agonists.
What is the age of normal pubertal development?
Hence 2.5% of normal girls have onset of puberty before age 8.
How to determine estrogen levels in childhood?
Estrogen levels in childhood determined by an ultra-sensitive recombinant cell bioassay. . . Use of an ultrasensitive recombinant cell bioassay to determine estrogen levels in girls with precocious puberty treated with an LHRH agonist.
Does HPGA increase with puberty?
The HPGA activity increases with the onset of puberty as evidenced by increasing number and amplitude of spontaneous pulses of gonadotropins, luteinizing hormone (LH), and follicle stimulating hormone (FSH), plus increased peak LH and FSH levels in response to GnRH stimulation ( 5 ).
Is precocious puberty true?
It involves not only early physical changes of puberty, but also linear growth acceleration and acceleration of bone maturation, which leads to early epiphyseal fusion and short adult height. Precocious puberty can be true or GnRH-dependent puberty, or it can be peripheral or GnRH-independent puberty.
Is adult height improved with treatment?
Adult height is improved with treatment ( 2, 3 ). Therefore, part of the decision of who to treat involves estimating adult height based on the child’s current height and bone age, and comparing this predicted height with mid-parental height (MPH) and with the normal population.
Is estradiol good for precocious puberty?
Estradiol levels have not been reliable for the diagnosis of precocious puberty. While some girls present the obviously pubertal estradiol levels, many girls present with estradiol levels below the detection limit of available RIAs, as in the girls reported by Palmert et al.
Why do we treat precocious puberty?
1. Treatment for precocious puberty can help stop puberty until the child is closer to the normal time for sexual development. One reason to consider treating precocious puberty is that rapid growth and bone maturation, caused by precocious puberty, can prevent a child from reaching his ...
What is the treatment for delayed puberty?
With delayed puberty or hypogonadism, treatment varies with the origin of the problem but may involve 2: In males, testosterone injections, skin patches, or gel. In females, estrogen and/or progesterone given as pills or skin patches.
What is the goal of sex hormone treatment?
The goal of treatment is to prevent the production of sex hormones to prevent the early halt of growth, short stature in adulthood, emotional effects, social problems, and problems with libido (especially in boys ).
