Precocious Puberty

Puberty that happens early is called precocious puberty. This means a child's physical signs of sexual maturity develop too soon. This includes breast growth, pubic hair and voice changes. These are known as secondary sexual characteristics. Precocious puberty happens before age 8 in girls and before age 9 in boys. Most children with the disorder grow fast at first. But they also stop growing before reaching their full genetic height potential.

It may be caused by tumors or growths on the ovaries, adrenal glands, pituitary gland or brain. Other causes may include central nervous system problems, family history of the condition or certain rare genetic syndromes. In many cases, no cause can be found for the disorder. There are two types of precocious puberty:

• Gonadotropin-dependent. This is also known as central precocious puberty. This is the most common type of precocious puberty. Most girls and half of boys with precocious puberty have this type. The puberty is started by early secretion of hormones called gonadotropins. Gonadotropins include luteinizing hormone (LH) and follicle stimulation hormone (FSH). In girls, precocious puberty may be caused by the early maturity of the hypothalamus, pituitary glands and ovaries. But in most cases, no cause can be found.
• Gonadotropin-independent. This is a form of precocious puberty that is not started by the early release of gonadotropins. Instead it’s caused by early secretion of high levels of sex hormones. These include the male androgens and female estrogens.

A child is at risk for precocious puberty if they have any of these:

• Tumors or growths on the ovaries, testes, adrenal glands, pituitary gland or brain
• Central nervous system problems
• Family history of the disease
• A rare genetic syndrome

The signs are secondary sexual characteristics that happen early.

Common signs in girls can include:

• Breast growth
• Pubic and underarm hair
• Menstruation
• Ovulation

Common signs in boys can include:

• Enlarging penis and testicles
• Pubic and underarm hair
• Facial hair
• Spontaneous erections
• Production of sperm
• Acne
• Deepening of the voice

Other signs of the disorder include:

• Moodiness
• Increased aggression
• Growing taller earlier than other classmates

The signs of precocious puberty can be like other health conditions. Make sure your child sees their health care provider for a diagnosis.

The health care provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. Your child will also have a physical exam.

Your child may have blood tests to measure levels of hormones such as:

• Luteinizing hormone (LH)
• Follicle stimulation hormone (FSH)
• A form of estrogen called estradiol
• Testosterone
• Thyroid hormones

Gonadotropin-stimulating hormone (GnRH) is made by the hypothalamus in the brain. It causes the pituitary gland to release gonadotropins. These then cause sex hormones to be made by the ovaries in girls, or the testes in boys. The GnRH blood test may show the type of precocious puberty.

Your child may also have tests such as:

• X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child's bone age. With precocious puberty, bone age is often older than calendar age.
• Ultrasound (sonography). This test uses sound waves and a computer to create images of blood vessels, tissues and organs. This may be done to look at the adrenal glands and ovaries or testes.
• MRI. This test uses large magnets and a computer to make detailed images of tissues in the body without the use of X-rays.

The goal of treatment is to stop the onset of early puberty signs. In some cases, the signs can be reversed. Treatment will depend on the type of precocious puberty and the cause.

Treatment may be done with medicines called synthetic gonadotropin-releasing hormone agonists. These can stop the sexual maturity process by stopping the pituitary gland from releasing the gonadotropin hormones.

Early puberty will cause a child's body and moods to change much sooner than their friends and classmates. This may make a child feel self-conscious and embarrassed, or be teased by other children.

You can help your child by treating them like normal, boosting their self-esteem and seeking a child counselor if more help is needed.

Call your child’s health care provider if you see signs of sexual development in a girl before age 8 or in a boy before age 9.