Early puberty = Pubertas praecox
Definition: appearance of one or more of puberty landmarks before the age of 9 years.
Types & causes:
* Isosexual: (early feminization of a girl),
– 2ry sex characters agree with genetic sex.
– True: (GnRH dependant) which is either:
1. Idiopathic (constitutional): 80 – 90 of cases
– Suspected when occurs near to the normal onset (6 years).
2. Organic (CNS lesions): no further inhibition of GnRH release:
– Congenital: hydrocephalus & cysts of 3rd ventricle.
– Inflammatory: post-encephalitis & post-meningitis.
– Neoplastic: hamartoma, craniopharyngioma & neurofibromatosis.
– False (pseudo): GnRH independent
♦ Estrogen secreting ovarian tumors.
♦ Ovarian cysts.
♦ Estrogen secreting adrenal tumors.
♦ 1ry hypothyroidism: there is concomitant ↑ of TRH, GnRH & prolactin.
♦ Iatrogenic: injection of contraception.
♦ McCune Albright syndrome: *Precocious puberty & ovarian cysts.
* Polyostotic fibrous dysplasia.
*Cafe au lait patches.
* Heterosexual (early virilization of a girl),
♦ 2ry sex characters don’t agree with the genetic sex.
♦ Usually due to: androgen secreting adrenal & ovarian tumors.
* Isolated premature pubertal events:
♦ Some isolated events are only accelerated without clinical evidence of
other estrogen effects of advancement of bone age.
♦ Usually a benign condition.
♦ Diagnosis: by exclusion.
History: * differentiate between isosexual & heterosexual types.
* exclude iatrogenic source of estrogen.
♦ Diagnoses McCune Albright syndrome.
♦ Neurological & ophthalmological examination: to exclude organic brain lesions.
♦ Manifestations of hypothyroidism & galactorrhea.
♦ For isosexual P.P.
– True: *Constitutional: by exclusion.
*CNS lesions: C.T. & MRI.
– False: * Ovarian causes: pelvic U/S.
* Hypothyroidism: TFT & X-ray hands.
* McCune Albright: radiological skeletal survey.
♦ For heterosexual P.P.
– Lab.: * serum testosterone.
* Serum DHEA-sulphate.
– Imaging: * pelvic U/S.
* Adrenal U/S.
* Treatment of the cause e.g. removal of ovarian tumor & T4 for hypothyroidism.
* Constitutional type:
Aim: suppression of gonadotrophins secretion to inhibit premature closure of epiphysis &
subsequent short stature.
– GnRH analogue: treatment of choice (no effect on bone growth).
– MPA injectable: little effect on bone growth.
– Cyproterone acetate: little effect on bone growth.
– Danazol: little effect on bone growth.
Duration: treatment is given till the age of 12 years (mean age of pubertal development).
Approach to precocious puberty:
♦ Bone age study: by x-ray to the lower end of radius & ulna.
At Stanford Medical School with Morgan Theis talking to Dr. Laura Bachrach talking about precocious puberty. Created by Sal Khan.
USMLE COMLEX Board Review of Precocious Puberty
Precocious puberty first aid, medical emergencies, emergency care, emergency preparedness, injuries, safety, health information, consumer information, medical health, wellness, health articles
Precocious Puberty’ By Dr. Kavitha Bhat, Consultant Pediatric Endocrinologist, Telerad RxDx Multispecialty Clinic. Approach to Maxillofascial trauma’ by Dr. Akshay Shetty, Consultant Maxillofascial Surgeon, Telerad RxDx Multispecialty Clinic.
QUICK PEDIATRICS: Precocious Puberty in Girls & Boys
Complete and incomplete precocious puberty
Definition of precocious puberty Precocious puberty is defined as the onset of secondary sexual characteristics before 8 yr of age in girls and 9 yr in boys.
Precocious Puberty and normal puberty
PRECOCIOUS PUBERTY DR SANTOSH MOGALI
Precocious puberty is one of the grey areas for pediatricians and gyenecologists. this is an attempt to answer some of the questions the content is references taken from authorative textbooks.
Onset of secondary sexual characters before the age of 8 years in girls and 9 years in boys.• Two types-central-gonadotropin dependent or true. Is always isosexual and stems from hypothalamic-pituitary- gonadal activation with ensuing sex hormone secretion and progressive sexual maturation.• Peripheral- gonadotropin independent or pseudo. some of the secondary sex characters appear, but no activation of the normal hypothalamic-pituitary-gonadal interplay. May be isosexual or heterosexual (contrasexual)