Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

Definition

Girls enter puberty between the ages of 8-14. Boys enter this stage between the ages of 9-14. Sometimes the physical changes may happen earlier. This is called precocious sexual development or premature puberty.

For girls, this means that before the age of eight they may:

  • Develop breasts
  • Have armpit or pubic hair
  • Have mature sex organs
  • Experience their first period
For boys, this means before the age of nine they may have:
  • Enlarged sex organs
  • Armpit, pubic, or facial hair

Causes

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

Some known causes of premature sexual development include:

Pituitary Gland

Pituitary
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Causes specific to girls:

  • Having ovarian tumor or cysts
  • Taking estrogen

Causes specific to boys:

  • Having tumors on the testicles
  • Taking male sex hormones (androgens)

Other causes:

Risk Factors

Factors that increase the risk of precocious puberty include:

Symptoms

One symptom common to both boys and girls is a premature growth spurt in height. Children with this condition may be taller than their peers. As an adult, they may be shorter. The rapid growth also makes their bones stop growing sooner than normal. Other symptoms include:

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. An x-ray of the left wrist bone may also be taken. This will help to assess if the bone growth is normal for your child’s age.

Depending on these results, other tests may be ordered, including:

  • Adrenal and pelvic ultrasound —images of kidneys and sexual organs created by sound waves
  • Testicular ultrasound if testicular enlargement is uneven
  • MRI of the brain—detailed images of the brain
  • Blood tests to measure the levels of hormones such as:
    • In girls: follicle-stimulating hormone (FSH), luteinizing hormone (LH)
    • In boys: testosterone
    • Human chorionic gonadotropin (hCG) levels—hormone that affects growth
    • Thyroid hormone levels—if hypothyroidism suspected
    • Growth hormone-releasing hormone (GHRH) stimulation test
    • Dehydroepiandrosterone (DHEA) levels—early form of sex hormones

Treatment

The treatment depends upon the cause.

If the bone age is about the same as the child's actual age and there is no known cause, there is no treatment. The child will continue to be monitored. Psychological support may be recommended if a child is struggling.

Other children may require treatment. This may include medication or surgery.

Medication is often used in children whose bone age is older than their actual age. These medications stop or slow sexual development. They also halt the rapid bone growth and encourage normal growth.

These medications called hormone suppressors may include:

  • Leuprolide acetate
  • Histrelin
  • Nafarelin

Metformin has also been shown to be effective in delaying puberty.

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.

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.

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

Most precocious development cannot be prevented. To help reduce the chance, make sure your child is kept as healthy as possible. This includes making sure they are eating well and getting all the nutrients they need. Help your child maintain a healthy weight. Avoid exposure to sex hormones.