Precocious puberty (PP) or Pubertas praecox (in latin) refers to children showing adult like changes earlier than normal.In girls before 7 years and in boys before 9 years of age.The pubertal changes include acne, pubic hair, auxillary hair , rapid growth , breast development (girls) or menstruation (girls). Age wise, pubic hair development before 8 years , breast development before 7 years or menstruation before 10 years is considered as PP. PP affects 1 out of every 5000 children and the youngest patient ever recorded was 5 years 7 months and 21 days – Linda Medina.
Types of Precocious Puberty :
Central precocious puberty :
The pituitary gland gets stimulated early to release GnRH (gonadotropin releasing hormone) which then causes a rise in oestrogen levels (E2) in the body (responsible for breast development and menstruation).
Peripheral precocious puberty :
This condition is also known as pseudo-puberty wherein the pituitary gland is not involved but rather the ovaries, testes, adrenal glands or an under active thyroid gland are responsible.
Isosexual precocious puberty :
This is a rare condition where instead of breast development the girl develops hoarseness of voice and facial hair. If a dose of GnRH agonist is injected and the level of E2 has risen then its considered as central PP.
Premature thelarche :
Young pre-pubertal girls who have early breast development.
Premature pubarche :
Also known as premature adrenarche ,it involves early development of pubic and under arm hair.
Causes of central precocious puberty :
95% of the time there are no actual causes for central precocious puberty
Brain injury :
Tumours , injury(haematoma) , inflammation or infection to the brain are the most common causes.
Bisphenol present in plastic is associated with precocious puberty.
Mutation in gene LIN 28 , LEP , LEPR or mutation in Kisspeptin KISS1 have been associated with premature GnRH activation.
Children affected by Mc Cune- Albright syndrome or congenital adrenal hyperplasia or hypothyroidism may be affected by precocious puberty.
Causes of peripheral precocious puberty :
Adrenal tumours ,ovarian cysts ,ovarian tumours or any external hormonal stimulants like oestrogen creams , ointments, food supplements , injections are likely to cause peripheral precocious puberty.
Other factors :
Obesity has been linked to increased rates of precocious puberty in recent studies. Adopted children taken overseas are 10 to 20 times more likely to develop precocious puberty. Household stress or high conflicts in the family have been linked to this disorder. Other causes like low self esteem, depression and eating disorders may also play a role.
So what are the consequences ?
This results in children being short statured,with behavioural abnormalities and possibly early sexual activity. There are studies showing that 30% of these children are susceptible to developing early breast cancer.
A general history, physical examination (anthropometry, pubertal staging) , blood investigations (including FSH,LH,E2,T4,TSH) , MRI and X-Ray bone age measurement will help assess the extent of pubertal signs. For patients with no diagnosed cause for precocious puberty , reassurance is sufficient because most of the time PP resolves spontaneously. A monthly dose of Leuprolide (GNRH antagonist) can be administered to delay pubertal symptoms. Every year puberty delayed until 12 yrs will reduce the chances of breast cancer by 9%. These particular patients also require psychological counselling as they are highly susceptible for teasing, bullying and sometimes even sexual abuse.
Keep children away from any kind of medications and make them follow a healthy weight throughout childhood (Leptin in fat stimulates GnRH). Avoid children from consuming caffeine, processed foods, canned food, sugar sweeteners, aeriated beverages or heavy ingestion of animal protein. Keep children especially away from Endocrine disruption chemicals(EDC) like pesticides, plastics, cosmetics, fuels, BPA , Aspartate etc. Make children consume water from glass bottles, eat whole plant foods and make them follow a “green diet” as much as possible. A good idea would be to increase their physical activity and make them follow a regular exercise routine.
At Indigo womens center we deal with patients with precocious puberty at a regular basis .We can provide you the necessary treatment ,counselling and ease you through these worrying times. We deal with patients with precocious puberty as a regular basis.