PRECOCIOUS PUBERTY

By Joseph Hazan,M.D., FACOG

 

Breast development in girls before age 8 is

considered as precocious puberty.

This is related to the first stage of puberty

which is gonadarche and is related

to the activation of estrogen production

in the ovaries as signals initiated from

the hypothalamic portion of the brain

are sent to the pituitary which then are

relayed to the ovaries in order to produce

estrogen.

Estrogen causes breasts to develop.

Additionally bone development has been

used in the criteria.

The second stage of puberty is adrenarche

which has to do with adult type

body odor and development of hair in

the arm pits and pubic area.

This is initiated by the activation of the

adrenal androgen levels as

prompted by the hypothalamus portion

of the brain signals the pituitary.

If there are seizures, headaches or visual

changes a brain related issue is

considered.

In some cases an external stimulus such

as hormone gel or cream might be

responsible. Products that contain placental

extracts, tea tree oil or lavender

oil could also be related to

precocious puberty.

The accelerated bone development is

evident in height measurements.

If height increases by more than 6 cm

a year this is usually consistent with

early puberty.

If a young girl has not started to develop

breasts but has  the characteristics of

premature adrenarche, it could be related

to insulin resistance, obesity and

high insulin levels.

Some of these girls could later develop PCOS

(polycystic ovarian syndrome).

Girls with premature adrenarche without

early onset of

breast development could be prone to

psychiatric problems.

Some of these girls who were small at birth

could en up starting their periods early

and might end up short, since the early

onset of their menses result in the early

epiphyseal maturation and therefore

short stature.

If estrogen levels are high without high

gonadotropin LH and FSH levels would

be related to an ovarian cyst or tumor.

LH and FSH levels are low with PPP

(precocious peripheral puberty)

but elevated with CPP (central precocious

puberty).

If the attainment of adult height potential

is wanted in cases of CPP the use of

GnRH analogs are considered to help delay

the onset of puberty.

REFERENCES

Carel JC, Eugster EA, Rogol A, et al.

Consensus statement on the use of gonadotropin-

releasing hormone analogs in children.

Pediatrics.2009;123(4):e752-e762.