Precocious puberty (early puberty)
Fast facts
- Precocious puberty is when puberty starts earlier than eight years of age in girls and nine years in boys.
- Most of the time there is no known cause of precocious puberty. In some case it can be the result of an underlying medical condition.
- Precocious puberty for which there is no underlying medical condition can be effectively treated with a monthly hormone injection.
- It is not always possible to prevent the onset of precocious puberty, but you can reduce your child's risk by encouraging them to maintain a healthy weight and by keeping them away from external sources of sex hormones.
X
Hormone
A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.
What is precocious puberty?
Puberty is the time in a young person's life when their body undergoes physical changes as they become sexually mature. Puberty begins with a series of hormonal triggers that start in the brain and result in the stimulation of a girl's ovaries or boy's testes to produce more sex hormones. This prompts changes such as the growth of facial hair in boys and the development of breasts in girls.
In the US, the average age for the onset of puberty is around 10 years for girls and 12 years for boys. However, in precocious puberty, this onset occurs earlier - before eight years of age in girls and before nine years in boys.
X
Testes
The male sex organs located in the scrotum that produce sperm.
Causes and risk factors
Precocious puberty is thought to be the result of a complex interaction between genetic, environmental and physical factors. The reason for puberty beginning early depends on the type of precocious puberty; in many cases it is not known.
Risk factors for precocious puberty include:
- Gender - it is more common in girls;
- Obesity - girls who are overweight are at greater risk;
- Various medical conditions (see below);
- Radiation therapy of the central nervous system, and;
- Exposure to sex hormones - external sources of estrogen and testosterone, such as some creams and ointments.
X
Central nervous system
The part of the body's nervous system that includes the brain and the spinal cord.
X
Estrogen
One of a group of steroid hormones involved in the development and maintenance of female sex characteristics. These are the primary female sex hormones.
X
Radiation
Energy that is emitted, such as heat, light, or energy in electromagnetic waves. Different types of radiation can be used to diagnose and treat disease.
X
Testosterone
A hormone that plays a key role in the development of male sexual characteristics and reproduction. It is produced by both sexes, but in much larger amounts in men.
Types
Central precocious puberty
Most of the time there is no known cause of central precocious puberty - puberty starts early in children with no underlying medical condition. However, in very rare cases this type of precocious puberty can be caused by:
- A tumor in the brain or spinal cord;
- A rare genetic disease called McCune-Albright syndrome that affects the skin and bones and causes hormonal problems;
- A group of genetic disorders that cause congenital adrenal hyperplasia, in which the adrenal glands produce too many hormones, or;
- Hypothyroidism, in which the adrenal glands do not produce enough hormones.
Peripheral precocious puberty
In peripheral precocious puberty, estrogen and testosterone are produced without the central control from the brain that normally triggers them. Sometimes they can be produced due to problems with the ovaries, testicles, pituitary gland or adrenal glands. Such problems include:
- A tumor in the pituitary gland or adrenal glands causing secretion of estrogen or testosterone;
- External sources of estrogen or testosterone, such as some creams or ointments;
- McCune-Albright syndrome;
- Ovarian cysts or tumors in girls;
- A testicular tumor in boys, or;
- Gonadotropin-independent familial sexual precocity, a rare genetic disorder in boys.
X
Congenital adrenal hyperplasia
A collection of genetic disorders involving altered production of hormones by the adrenal glands resulting in lowered cortisol and aldosterone levels and elevated androgen levels in both men and women.
X
Estrogen
One of a group of steroid hormones involved in the development and maintenance of female sex characteristics. These are the primary female sex hormones.
X
Spinal cord
A bundle of nerve tissue that runs from the brain through the spinal column and connects the brain to the body, transmitting sensory and motor signals.
X
Testosterone
A hormone that plays a key role in the development of male sexual characteristics and reproduction. It is produced by both sexes, but in much larger amounts in men.
X
Tumor
A growth caused by an abnormal and uncontrolled reproduction of cells.
X
McCune-Albright syndrome
A condition characterized by replacement of bone with abnormal tissue and brown spots on the skin.
X
Testicular
Relating to the testicles, the male reproductive organs that produce sperm and the hormone testosterone.
Signs and symptoms
Signs and symptoms of precocious puberty include:
- Growth of breasts or occurrence of the first period in girls;
- A deepening voice, growth of facial hair, or enlarged penis and testicles in boys, and;
- Rapid growth, acne, pubic or underarm hair or an adult body odor in boys or girls.
Precocious puberty symptoms include acne and growth of facial hair.
X
Penis
An external part of the male genitals, through which semen and urine pass.
Methods for diagnosis
A doctor will diagnose precocious puberty by:
- Physical examination and taking a medical history;
- Blood tests that measure hormone levels, and;
- X-rays of the hand and wrist to determine if bones are growing too quickly.
GnRH test
In order to determine the type of precocious puberty, the gonadotropin-releasing hormone stimulation (GnRH) test is performed. GnRH is a hormone the brain releases that begins the chain reaction that triggers puberty.
A shot of GnRH is given to the child, and a blood sample is then taken to see if it causes an increase in levels of other hormones. If the child has peripheral precocious puberty, their other hormone levels will not rise.
Additional tests
If peripheral precocious puberty is suspected, additional tests to determine the cause can be performed, including:
- Additional blood tests, and;
- Ultrasound to check for ovarian cysts or tumors.
If central precocious puberty is suspected, then additional tests will include:
- Magnetic resonance imaging (MRI) of the brain to check for any abnormalities, and;
- Thyroid testing, to check the thyroid gland is working normally.
X
Blood tests
During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analyzed to help diagnose and monitor a wide range of health conditions.
X
Hormone
A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.
X
MRI
A type of imaging that uses a magnetic field and low-energy radio waves, instead of X-rays, to obtain images of organs.
X
Thyroid
A large gland located in the lower front part of the neck that produces hormones that regulate metabolism, growth and development, especially during childhood.
Types of treatment
Treatment of precocious puberty depends on its type and cause.
Central precocious puberty for which there is no underlying medical condition can be treated with GnRH analogue therapy: every month your child will be given an injection of a drug such as leuprolide, to suppress puberty until the normal age of onset.
If there is an underlying medical condition causing precocious puberty, then it will be treated separately; for example, by removing a tumor if it is causing precocious puberty by secreting hormones.
X
Tumor
A growth caused by an abnormal and uncontrolled reproduction of cells.
Potential complications
Complications of precocious puberty include:
- Emotional problems - children who undergo puberty earlier than their peers can be self-conscious, which may affect their self-esteem, and;
- Shorter height in the long term - although children with precocious puberty usually grow taller than their peers when young, they also tend to stop growing earlier than usual, so they often end up shorter as adults.
Prognosis
Treatment outcomes depend on the type of treatment and cause.
In most cases, hormone therapy is very successful at stopping puberty. Puberty will start again about 16 months after the injections are stopped.
X
Hormone
A chemical substance secreted in one part of an organism and transported to another part of that organism, where it has a specific effect.
Prevention
It is not always possible to prevent the onset of precocious puberty, but you can reduce your child's risk by encouraging them to maintain a healthy weight and by keeping them away from external sources of sex hormones (estrogen and testosterone), such as some prescription medications and dietary supplements.
X
Estrogen
One of a group of steroid hormones involved in the development and maintenance of female sex characteristics. These are the primary female sex hormones.
X
Testosterone
A hormone that plays a key role in the development of male sexual characteristics and reproduction. It is produced by both sexes, but in much larger amounts in men.
10 Most frequently asked questions (FAQs)
What is precocious puberty? Precocious puberty is the early onset of puberty, occurring before nine years of age in boys and eight years in girls. What are the symptoms of precocious puberty? Signs and symptoms of precocious puberty include the appearance of acne and body hair accompanied by rapid physical growth and sexual maturity, including the growth of breasts or occurrence of the first period in girls and an enlarged penis and testicles in boys. What causes precocious puberty? Precocious puberty has a number of causes. Often it occurs because the body produces sex hormones earlier than usual for no apparent reason, but sometimes this can happen as a result of underlying medical conditions. How is precocious puberty diagnosed? A number of tests are used to diagnose precocious puberty. Usually it begins with a medical history, a physical examination, and blood tests that check hormone levels. An X-ray of the hand is also performed to check if bones are growing faster than normal. If precocious puberty is suspected after this, a range of other tests are performed to determine the type and cause. How is precocious puberty treated? Treatment of precocious puberty depends on the type and cause. Sometimes a monthly injection is enough to block the process of puberty. However, sometimes there are underlying medical conditions causing the production of the hormones that are triggering puberty, such as hormone-secreting tumors. These need to be treated separately. Can precocious puberty be prevented? Precocious puberty cannot be completely prevented, but you can reduce the risk of your child having it by preventing their exposure to external sources of estrogen and testosterone - which can be found in certain prescription medications and dietary supplements - and by making sure they maintain a healthy weight. Are there different types of precocious puberty? There are two types of precocious puberty, central and peripheral. Central precocious puberty in most cases has no underlying causes. In rare cases, it may be caused by a tumor, genetic disorder or hypothyroidism. Peripheral precocious puberty occurs as a result of estrogen and testosterone production without the central control from the brain that normally triggers them. This may be due to problems with the ovaries, testicles, pituitary gland or adrenal glands. What is the outlook for precocious puberty? The outlook for precocious puberty depends on the type and cause. Most of the time a monthly injection is all it takes to stop puberty in its tracks until the normal age of puberty, at which time the injections are stopped. However, sometimes precocious puberty can be caused by underlying medical problems, such as a genetic condition, or from hormone-secreting tumors in the body. In cases like these, the outcome for precocious puberty varies and depends on the exact cause and the individual's response to treatment.
Related topics
Acne is a common skin condition that causes outbreaks of pimples and cysts, mainly on the face, back, arms and chest. It occurs when hair follicles become blocked with oil and/or debris, such as dead skin cells. Anyone can get acne, but it's more common during the teenage years. Treatment options are available to help prevent and treat acne. Osgood Schlatter disease is a condition that can cause pain in the knees of children and adolescents. It arises when the patellar tendon, which attaches the kneecap to the shinbone, becomes too tight, leading to inflammation and damage to the shinbone, in the area just below the kneecap. Wisdom teeth usually appear during the late teens or early twenties and are found at the very back of the mouth. Wisdom teeth do not usually require any treatment. However, if they do become impacted then they may need to be removed. This is usually a straight forward procedure.