Puberty is the transition from childhood to adult life. Onset- Pulsatile GnRH “nocturnal LH, FSH, estradiol. Puberty normally starts from the ageof 10 years till 13-14 years .
Tanner stages are used to describe the stages of puberty In Girls , breast budding is the first sign of puberty .
Precocious puberty is defined as the appearance of secondary sexual characteristics before the age of 8 years in girls and 9 years in boys.
Precocious puberty has been divided into two categories:
gonadotrophin-dependent puberty/Central
gonadotrophin-independent puberty/peripheral
Gonadotrophin-dependent puberty occurs when the HPG axis is prematurely activated.
In Peripheral precocious puberty, HPG axis is not involved.
| Central Precocious Puberty | Peripheral Precocious Puberty |
| Central precocious puberty Peripheral precocious puberty Idiopathic (74%) Central nervous system pathology/lesion – Hypothalamic hamartoma – Tumour: astrocytoma, glioma, craniopharyngioma, pituitary adenoma – Congenital disorder: hydrocephalus, myelomeningocele, arachnoid cyst -Acquired: central nervous system irradiation, post head trauma, post infection: encephalitis/meningitis, chemotherapy | Estrogen-secreting: granulosa cell tumour, functional ovarian cyst -Androgen-secreting: Sertoli–Leydig cell tumour, arrhenoblastoma (contrasexual) – Adrenal cause – Congenital adrenal hyperplasia (contrasexual) – Cushing syndrome (contrasexual) – Neoplasm: estrogen or androgen-secreting adenoma/carcinoma (isosexual or contrasexual) – Exogenous sex hormones: e.g. oral contraceptives, skin cream, anabolic steroid – McCune Albright syndrome – Severe longstanding hypothyroidism |
Problems to children with Precocious Puberty
–
Problems
Psychological difficulties, Behavioral problems , emotional problems. Bone maturation is accelerated – so adult height is reduced.
HISTORY
-Age of onset, Sequence of chhanges
Family history
Neurological symptoms
Use of any drugs
EXMAINATION- Height, weight, BMI, Tanner staging, Neurological exam, Visual field testing
Skin examination
Abdominal examination
Examination of external Genitalia
Signs of virilization
IMAGING- Left wrist X-ray for bone age
– Pelvic ultrasound (size, shape of uterus, endometrial thickness and ovarian morphology)
– Cranial CT or MRI
-CT adrenals (adrenal masses)
-Skeletal survey/bone scan
TREATMENT- Directed at the underlying cause.
Goals of treatment- halt or cause regression of secondary sexual characteristics
prevent early menarche retard skeletal maturation and
improve final height avoid psychosocial/behavioural sequelae.
Gonadotrophin-releasing hormone analogues (GnRHa) are the mainstay of treatment.