The Latin term Pubertas praecox means “premature puberty”. This means the onset of puberty before the age of eight (for girls) and the onset of puberty before the age of nine for boys.
What is precocious puberty?
Precocious puberty is diagnosed when the development of secondary sexual characteristics, such as breast growth or pubic hair, begins long before the usual age. Increased growth in length can also be observed in affected children.
Since the reason for precocious puberty can be a tumor in the liver, brain or thyroid gland, the growth of which affects hormone regulation, or precocious puberty can trigger short stature in the person concerned, precocious puberty is considered pathological and should be treated. See topbbacolleges for Definitions of Hospitalism.
In order to be able to treat the disease, the pediatrician first investigates the causes of the early onset of pubertal development. For example, a tumor can stimulate overproduction of sex hormones by simulating the endocrine gland, so that puberty is initiated early. It is also conceivable that the regulatory hormones of the sex hormones are not released in sufficient numbers.
This refers to the androgenital syndrome, a metabolic disease that needs to be treated with regular hormones. Precocious puberty can also be genetic; in this case, treatment is still advisable, since a premature growth spurt means that those affected run the risk of hardly growing any more later and thus only reaching a very small height.
Symptoms, Ailments & Signs
Precocious puberty may be present if children show signs of physical and mental development that are characteristic of puberty at a very early age. The deadline for girls is when they reach the age of eight, for boys when they reach the age of nine – from this age one no longer speaks of premature puberty. The progression of early puberty can be very rapid, but it can also be slow. Impure skin or even acne, greasy hair, vaginal dischargeor the onset of menstruation before age eight should alert parents. A change in personality can also indicate early puberty. Precocious puberty is about five times more common in girls than in boys.
Diagnosis & course of disease
As a rule, the pediatrician is the first point of contact in the event of early puberty. In a family history, he establishes whether the parents of the affected child have previously suffered from similar symptoms; this gives clues to the genetic disposition under which precocious puberty sometimes occurs. Tests are also required to rule out the presence of a tumor.
An illness is not always present when puberty begins unusually early. If a doctor can rule out that the symptoms are pathological – i.e. caused by an illness – therapy may still be necessary to stop early puberty again. Even if such treatment does not seem necessary at first, the further course of puberty should be closely monitored. Because early puberty has an influence on the development of height. For this reason, one of the examinations that a doctor carries out in the course of treating precocious puberty includes an X-ray examination of the bones in the hand.
With the X-ray, he determines the so-called skeletal age (also called bone age). The skeletal age can deviate from the chronological age insofar as certain cartilages and adhesions of the skeleton are already more advanced than those in a representative comparison group. With the help of this comparative data, the doctor can thus determine that the skeletal age is ahead of the chronological age by a certain number of years. This finding can then be used to make a prognosis for the probable future height of the person concerned.
If necessary, an early onset of puberty can then be treated with hormones to ensure that the affected child grows to an appropriate height in adulthood. With this concern, those affected should turn to specialists: in a pediatric endocrinologist, both the necessary examinations and the treatment can be carried out. Of course, before treating the early onset of puberty as such, it must be checked whether another disease is at the root of the pubertal development.
If precocious puberty is triggered by a tumour, possible complications initially result from the underlying disease and its treatment. In the case of benign growths, surgical removal is usually possible without serious complications to be expected. An exception here, however, are brain tumors, the surgical removal of which is almost always risky. If chemotherapy is indicated for malignant tumors, the complications usually result from the side effects.
If a tumor can be ruled out as the cause of the early onset of puberty, serious complications can only be expected if the disorder could be accompanied by short stature or dwarfism (microsomia). If this danger exists, the precocious puberty must be treated with hormones, otherwise those affected will no longer reach their normal height.
If the early onset of puberty is not pathological, complications can primarily arise when the affected children can no longer cope with their peers due to their physical and usually also mental changes. Because of this risk, treatment of precocious puberty should be considered even if it is not absolutely necessary for medical reasons. Hormonal therapy can be associated with side effects that must be discussed individually. Complications are not to be feared.
When should you go to the doctor?
Precocious puberty should always be treated by a doctor. There is no self-healing, and the disease cannot be treated by self-help either. Early treatment has a positive effect on the further course of precocious puberty and can prevent further complications and symptoms. A doctor should be consulted if the person affected suffers from severe acne, which is accompanied by greasy hair or a heavy discharge from the vagina. The symptoms usually appear very spontaneously and can take on different forms.
However, if the symptoms last longer and do not go away on their own, a doctor must be consulted in any case. Since precocious puberty can also promote the formation of tumors, regular check-ups should be carried out in order to detect and treat cancer at an early stage. As a rule, the life expectancy of those affected is not negatively influenced by precocious puberty. The disease can be treated by a pediatrician or by a general practitioner. However, it may be necessary to see a specialist.
Treatment & Therapy
Hormone administration can stop the onset of puberty again. This is advisable when there are no pathological reasons for the onset of puberty and when it is suspected that early development has a strong influence on the height of those affected. In this case, only at a later point in time, when the affected child has reached an appropriate level of mental maturity and the skeletal age has roughly matched the chronological age, is the regular administration of the delaying medication stopped again.
The drugs leuprolerin or triptolerin are approved in Germany for the treatment of early puberty. They are administered directly in the practice through an injection into the subcutaneous fatty tissue. The hormone depot created in this way then blocks the release of puberty hormones. Once a month, the hormone depot has to be replenished with another injection. This type of treatment has no known side effects.
Precocious puberty occurs when hormone regulation of the sex hormones is disturbed. Since there are no ways of influencing this, it is not possible to prevent early puberty.
Individual therapy is very important for the aftercare of successfully treated precocious puberty. This should be made dependent on the underlying diseases. It may also be necessary to take medication that reduces the formation of sex hormones (so-called GnRH analogues) after treatment of precocious puberty, since untreated patients produce too many sex hormones throughout their lives.
This is particularly important for the prevention of bone diseases and malformations. If puberty is to be initiated at an older age, close monitoring and therapy are necessary to achieve normal height growth. The hormone level should be checked regularly by taking blood samples from the doctor.
If a distant tumor of the liver was the cause of pubertas praecox, it is absolutely necessary to carry out regular check-ups with the doctor in order to detect a new tumor at an early stage. In addition, a lifelong liver-friendly diet (renunciation of offal and low-fat diet) may be necessary. If precocious puberty was due to a genetic disease such as adrenogenital syndrome, it is important to continue treating it even after precocious puberty has been successfully treated.
Lifelong intake of cortisol and progesterone may be necessary. With intensive monitoring of the hormone levels in the blood, long-term therapy should be discussed with the attending physician.
You can do that yourself
When diagnosing precocious puberty, it must first be clarified whether the early puberty was triggered by a tumor. It should then be treated as an underlying condition.
If the disease is not caused by a tumor, a decision must be made as to whether the patient should be treated with hormones. This decision should be made by the parents early on, as precocious puberty can lead to short stature. Here parents should follow the recommendations of their endocrinologist. If medication is prescribed, it must be taken regularly.
It is certainly not easy for both the patients and their parents to deal with precocious puberty. The children feel like outsiders because they are not at the same level of physical development as their classmates and may even be bullied. At the same time, they are often irritable, moody and unbalanced, which can drive parents to despair. Therefore, both the parents of the affected children and the children themselves should seek psychological care.
There are no special self-help groups for this disease, which may be due to the fact that it is rare and no longer relevant after puberty. However, there are various forums on the Internet where those affected can exchange information.