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Precocious Puberty(Precocious Sexual Development, Premature Puberty)
Definition

Precocious puberty is the unusually early onset of puberty. Typically, this is before:

  • Age 8 years in girls
  • Age 9 years in boys
Causes

Puberty is a complex process of brain, body, and hormonal development. If your child begins puberty at an early age, it may just be a variation in the range of what is considered normal.

In about 25%-75% of affected boys, this condition is due to underlying medical conditions. However, for many girls and some boys there is no known cause.

In rare cases, precocious puberty may be caused by conditions such as:

  • Congenital adrenal hyperplasia
  • McCune-Albright syndrome
  • Tumors or disorders of the testicles, ovaries, or adrenal gland
  • hCG-secreting tumors
  • Hypothalamic hamartoma (HH)—a rare benign brain tumor near the hypothalamus
  • Severe hypothyroidism

Other causes:

  • Acute head trauma
  • Central nervous system infection
  • Radiation treatment
  • Taking estrogen in girls
  • Taking male sex hormones in boys

Abnormalities in Adrenal Glands or Hypothalamus May Lead to Precocious Puberty

Kidney and adrenal

Copyright © Nucleus Medical Media, Inc.

Hypothalamus

Copyright © Nucleus Medical Media, Inc.

Risk Factors

Factors that may increase your child's risk of a precocious puberty include:

  • Gender: female
  • Ethnicity: Black, Hispanic
  • Family history—some cases may run in families
  • Head injury
  • Infection in brain
  • History of radiation therapy to the brain
  • Taking sex hormones
  • Some studies have suggested a link between obesity and premature puberty
Symptoms

Symptoms of precocious puberty in girls may include:

  • Development of breasts, pubic hair, and underarm hair
  • Ovary enlargement
  • Cysts on ovaries
  • Menstrual bleeding

Symptoms of precocious puberty in boys may include:

  • Growth of penis and testicles
  • Development of pubic and underarm hair
  • Muscle growth
  • Voice changes
  • Facial hair

Symptoms in both boys and girls include:

  • Body odor
  • Acne
  • Behavior changes
  • Growth spurt
Diagnosis

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. An assessment of puberty milestones and growth will be done. Your child may be referred to an endocrinologist, which is a doctor who specializes in hormonal, glandular, and metabolic disorders.

Images may be taken of your child's bodily structures. This can be done with:

Your child's bodily fluids may be tested. This can be done with blood tests.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Medications

Different medications can be used to treat precocious puberty depending on the type. These medications stop or slow sexual development. They also halt the rapid bone growth and encourage normal growth.

Psychological Support

Developing before their peers may cause social challenges in some children. Psychological support may be helpful. Talk to your child's doctor about what options are available.

Treatment of Underlying Conditions

If an underlying condition is the cause of precocious puberty, treatment will involve treating the specific medical problem.

Surgery

Surgery may be needed if the early puberty is caused by a tumor or other lesions. The procedure will depend on the location and size of the tumor.

Ongoing Monitoring

The doctor will continue to check your child’s height, weight, and sexual development. This will help to note any changes or show if the treatment has been effective.

Prevention

There is no known way to prevent precocious puberty.

RESOURCES:

National Institute of Child Health and Human Development
http://www.nichd.nih.gov

Nemours Foundation
http://www.kidshealth.org

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

The Hospital for Sick Children
http://www.aboutkidshealth.ca

References:

Baron J, Barnes K. Regulation of skeletal growth. National Institute of Child Health and Human Development: Annual report of the Division of Intramural Research; 2004. Accessed June 27, 2007.

Blondell RD, Foster MB, Kamlesh CD. Disorders of puberty. Am Fam Physician. 1999 Jul 1;60(1):209-218. Available at: http://www.aafp.org/afp/990700ap/209.html. Accessed July 16, 2013.

Cesario SK, Hughes LA. Precocious puberty: a comprehensive review of literature. J Ob Gyn Neonatal Nurs. 2007;36:263-274.

Himes JH, Obarzanek E, et al. Early sexual maturation, body composition, and obesity in African-American girls. Obesity Research. 2004;12:64S-72S.

Papathanasiou A, Hadjiathanasiou C. Precocious puberty. Ped Endocr Rev. 2006;3:182-187.

Precocious puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 3, 2013. Accessed July 16, 2013.

Puberty and precocious puberty. National Institute of Child Health and Human Development website. Available at: http://www.nichd.nih.gov/health/topics/puberty/Pages/default.aspx. Updated April 3, 2013. Accessed July 16, 2013.

VN Brito, AC Latronico, et al. Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arq Bras Endrocrinol Metab. 2008; 52(1):18-31.

Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics. 2002;110:903-910.

12/13/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Biro FM, Galvez MP, Greenspan LC, et al. Pubertal assessment method and baseline characteristics in a mixed longitudinal study of girls. Pediatrics. 2010;126(3):e583-590.



Last reviewed July 2013 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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