Puberty is a phase of rapid growth and development that involves physical growth and sexual maturation, along with psychological and social development. The normal age of puberty in girls is 8-12 years whereas in boys it is 10-14 years. Precocious puberty refers to early puberty.
The signs of precocious puberty in girls include:
The signs of precocious puberty in boys include:
Generally puberty is a result of increased hormonal levels in the body, stimulated by the hypothalamic-pituitary-gonadal axis. This stimulation triggers the hypothalamus to secrete gonadotropin-releasing hormone (GnRH). In response to GnRH, the pituitary gland starts releasing luteinizing hormone (LH), which induces the special cells present in the testes and ovaries to produce sex hormones, i.e. testosterone and oestrogen respectively. The increased levels of the specific sex hormones are responsible for the development of secondary sexual characteristics.
Based on the cause of increased hormonal secretion, precocious puberty can be categorized as:
In central precocious puberty, underlying causes responsible for precocious puberty remain unidentified. The majority of patients, suffering from this condition, are medically fit, without any identifiable cause for early puberty. In rare cases, central precocious puberty may be secondary to any of the following conditions:
Peripheral precocious puberty (PPP) is a less common condition, in which the Gn-RH is not involved in triggering early puberty. In PPP there is an increased level of sex hormones, i.e. testosterone and oestrogen, secondary to:
The possible complications of precocious puberty are as follows:
The diagnosis of precocious puberty involves physical examination, family history and medical history of the child. The bone growth can be assessed by X-rays of the wrist bone, for evaluation of normal growth. Gn-RH Stimulation test is recommended for determining the type of precocious puberty. The additional tests that may be employed for testing CPP include MRI scan of the brain and thyroid testing, whereas for PPP additional tests may include certain blood tests and ultrasound for detecting ovarian cysts or tumours.
The treatment of central precocious puberty involves certain medications, called Gn-RH analogue therapy, that delay the onset of puberty. In peripheral precocious puberty the underlying medical condition causing puberty also needs to be treated. The treatment may include surgical removal of the tumour, which is causing precocious puberty.