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Precocious Puberty

Precocious Puberty
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Puberty is marked by physical changes such as growth of pubic hair, breast development in girls and testicular development and penile enlargement in boys. Boys start puberty within a wide range of ages, but most boys start puberty between the ages of 9 and 14. Girls typically develop signs of puberty between the ages of 7 or 8 and 13.

Precocious puberty in girls is when the following happens before the age of 8:

  • Progressive breast development with menstruation beginning two to three years after
  • Accelerated growth

Precocious puberty in boys is when the following happens before the age of 9:

  • Penile enlargement
  • Testicular development
  • Increased muscle development
  • Voice change
  • Growth of body hair
  • Accelerated growth

There are two types of precocious puberty:

  • Central precocious puberty (CPP). Central precocious puberty is when the normal process of puberty starts too early. Most of the time there is no underlying medical cause. Less commonly, CPP may be caused by an abnormal pituitary gland or a problem with the hypothalamus.
  • Peripheral precocious puberty (PPP). Peripheral precocious puberty occurs when the sex hormone glands (adrenal glands in boys and girls, ovaries in girls and testes in boys) begin functioning earlier than normal. This type of precocious puberty is less common. Reasons the adrenals, ovaries and testes may begin to function earlier than normal include:
    • An adrenal tumor that secretes estrogen (hormones that promote the development of female characteristics) or testosterone (a steroid hormone that promotes the development of male characteristics)
    • A genetic abnormality called congenital adrenal hyperplasia (CAH) that causes the adrenal glands to make too much androgen (hormones that promote the development of male characteristics)
    • Exposure to medicines, creams, ointments or supplements that contain estrogen, androgen or testosterone
    • Ovarian cysts or ovarian tumors in girls
    • Tumors in the testicles in boys

There are two common forms of precocious puberty that do not require any treatment:

  • Premature thelarche. Premature thelarche causes a small amount of breast development in girls without any other changes of puberty. The breast development does not progress and eventually goes away. This often occurs in toddler girls.
  • Premature adrenarche. Premature adrenarche occurs when the normal secretion of androgens from the adrenal glands begins unusually early. This leads to small amounts of pubic hair and adult body odor in boys and girls, which increase very slowly. No other signs of puberty are usually present. These changes progress so slowly that the children do not need treatment.

Diagnosis of Precocious Puberty

If your child is developing faster than normal, it may be due to precocious puberty. Doctors at Riley at IU Health can perform the following exams and tests to make a diagnosis:

  • Physical exam. The doctor can compare your child's growth and pubertal development with the growth and pubertal development of children of the same age and gender.
  • Blood test. A blood test may be used to check pituitary hormones, sex hormone levels (estradiol or testosterone) and other hormones. The doctor may inject your child with the synthetic hormone leuprolide before measuring these hormones. Leuprolide makes it easier to interpret the results of your child’s test.
  • Bone age test. Your child’s doctor may perform a bone age test, which is an X-ray of the left hand and wrist. This test can show how far along in puberty your child is and may show if early puberty will affect your child’s height as an adult.
  • Magnetic resonance imaging (MRI). If a blood test indicates central precocious puberty, the doctor may perform a MRI scan of the brain to look for an abnormality in the pituitary gland.

Treatments

Treatments

Treatment of precocious puberty depends on if your child is diagnosed with central precocious puberty or peripheral precocious puberty:

  • Central precocious puberty. Some forms of CPP do not require any treatment, particularly if it is slowly progressing and your child is close to the normal age. If treatment for CPP is required, the goal is to temporarily stop production of luteinizing hormone (LH) and follicle stimulating hormone (FSH) by the pituitary gland. A gonadotropin-releasing hormone (GnRH) agonist is used to treat CPP and suppress pituitary gonadal function. A GnRH agonist is typically given as an injection every month or every three months or as an implant that slowly releases the medicine over the course of one year. This medicine slows the signs of puberty and delays the onset of menstruation in girls. Sometimes, this treatment may allow a child to be taller than they would have been without treatment.
  • Peripheral precocious puberty. Treatment of PPP varies depending on the cause. If the cause is a tumor that is producing estrogen or testosterone, treatment may include removal of the tumor. The doctor may also prescribe medicines that suppress or stop estrogen or testosterone production.

Children going through precocious puberty may experience stress and anxiety because their bodies are developing quicker than their minds. They may be mistaken for a much older age, and this can be confusing or embarrassing.

If your child has been diagnosed with precocious puberty, treatment can slow down or delay puberty, allowing your child to grow to a more normal height.

Key Points to Remember

Key Points to Remember

  • Precocious puberty is defined as the onset of puberty before the age of 7 or 8 in girls and age 9 in boys.
  • An abnormal pituitary gland or hypothalamus may cause precocious puberty. This is referred to as central precocious puberty.
  • Peripheral precocious puberty occurs when sex hormone glands start working earlier than they should.
  • Central precocious puberty is treated with a medicine that slows production of luteinizing hormone (LH) and follicle stimulating hormone (FSH) by the pituitary gland.
  • Peripheral precocious puberty is treated with medicines that suppress or stop the production of hormones or surgery to remove tumors that produce estrogen or testosterone.

Support Services & Resources

Support Services & Resources

Visit the links below to learn more about precocious puberty and discover support groups and resources.

We offer a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

Pediatric Endocrine Society

The Pediatric Endocrine Society provides detailed information about precocious puberty.

MedlinePlus

Learn more about precocious puberty on this website by the U.S. National Library of Medicine.

Departments Treating This Condition

Departments Treating This Condition

  • Diabetes & Endocrinology
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