Precocious puberty is a term denoting the early onset of puberty in young children. Typically the physical signs of precocious puberty appear in boys before the age of nine and the ages of seven or eight in girls. The common indicators for precocious puberty in both sexes are the appearance of pubic and underarm hair, acne, sudden rapid increase in height and body odor associated with older children. Boys can experience a deepening of the voice, enlargement of the genitals and facial hair growth, whereas girls may have incipient breast development and begin to menstruate. Girls can be capable of reproduction. Bone structure can be considered to be that of an older child.
There are two kinds of precocious puberty, each due to different possible causes: central and peripheral. The causes of central precocious puberty include:
- hydrocephalus – fluid on the brain
- intracranial neoplasm – brain tumor
- Langerhans cell histiocytosis – abnormal proliferation of Langerhans cells
- ΜcCune-Albright syndrome (ΜAH) – genetic condition involving hormonal disorder
- hypothalamic hamartoma – cerebral malformation due to secretion of Gonadotropin-releasing hormones (GnRH)
Peripheral precocious puberty can be due to:
- adrenal tumors
- gonadal tumors
- germ-cell tumors
- congenital adrenal hyperplasia (CAH) – genetic disorder associated with excessive sex steroid production
The social consequences can be very challenging for children. Emotional difficulties can arise from stress, social exclusion and bullying. A child with precocious puberty can be susceptible to strange new feelings very difficult to understand and cope with, and comparisons with the bodies of his or her peers will present that child with deeply uncomfortable emotions around body image and self-esteem. This burden on the the child may push him or her into maladaptive behaviors. For example, girls who mature early can be sexually active and have a higher propensity for substance abuse and suicide.
However, precocious puberty is manageable. Blood tests can detect sex steroid levels, ultrasound can uncover tumors in the uterus or testicles, and X-rays of hands and wrists can determine bone age. GnRH agonists are used to treat ΜAH, glucocorticoids treat CAH, and Testolactone retards steroid production in ΜAH. Flutamine counters androgen excess.