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Pediatric Precocious Puberty (Early Puberty)

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Summary

Precocious puberty, also known as early puberty, is a condition in which a child’s body begins to mature at an abnormally early age (before age 8 in girls or before age 9 in boys).

Expanded Overview

In girls, the first sign of puberty is usually breast development, followed by hair growth in the pubic area and armpits and then menstruation (a monthly period). In boys, puberty usually begins with growth of the genital organs, followed by hair growth in the pubic area and armpits and then the development of muscles, facial hair and a deeper voice. Both boys and girls may experience acne and both will usually have a growth spurt, bringing them closer to their adult height.

Puberty is activated by certain genes and hormones. An area of the brain known as the hypothalamus activates gonadotropin-releasing hormone, which signals the pituitary gland (at the base of the brain) to release hormones that stimulate the ovaries in  girls or testicles in boys to produce sex hormones.

Types

There are two types of precocious puberty:

  • Central precocious puberty - early onset puberty that usually has no known cause.
  • Peripheral precocious puberty - early puberty that is caused by a problem with the ovaries, testicles, adrenal glands or pituitary gland.

Causes

In many cases, there is no known cause for precocious puberty. In other cases, it may be caused by:

  • Central nervous system abnormalities
  • Family history of precocious puberty
  • Tumors or growths in the ovaries, adrenal glands, pituitary gland or brain
  • Other genetic conditions

Symptoms

Although symptoms may vary from child to child, symptoms of precocious puberty may include:

Girls:

  • Acne
  • Breast growth
  • Early menstruation
  • Growing pubic and underarm hair
  • Rapid growth (girls who go through puberty too early may not reach their full height because growth stops too early)

Boys:

  • Acne
  • Deepening of the voice
  • Enlarging penis and testicles
  • Growing pubic, underarm and facial hair
  • Rapid growth (boys who go through puberty too early may not reach their full height because growth stops too early)

Other characteristics of precocious puberty may include:

  • Increased aggression
  • Moodiness associated with the hormonal changes

Tests and Diagnosis

There are several methods used for diagnosing precocious puberty. Your child’s doctor may use a combination of these methods:

  • Family history
  • Physical exam
  • X-rays
  • Blood tests
  • Ultrasound

Treatment

Treatments for precocious puberty may include:

  • Medications (GnRH analogs) to block the hormones that are bringing on puberty
  • Treating any contributing medical conditions (e.g., tumor)

Risk Factors

Precocious puberty is more common in girls than in boys and occurs more often in African-Americans than in children of other races. Other risk factors may include:

  • Certain medical conditions (e.g., McCune-Albright syndrome, congenital adrenal hyperplasia)
  • Exposure to estrogen or testosterone hormones (e.g., pills, ointments)
  • Obesity
  • Previous radiation to the brain or spinal cord

The changes to your child’s body brought on by precocious puberty may cause him (or her) to feel self-conscious, and may also lead to teasing by peers. Counseling may help your child to work through these issues.

Resources

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