Precocious Sexual Development
(Precocious Puberty; Premature Puberty)
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:
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:
- Sex: girls are 2 to 5 times more likely to experience premature puberty than boys
- Family history—some cases may run in families
- Taking sex hormones
- Head injury
- Radiation of head
- Infection in brain
-
Some studies have suggested a link between
obesity
and premature puberty
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:
-
In girls, early arrival of:
- Breast development
- Pubic hair
- Armpit hair
- Onset of period
- Ovary enlargement
- Cysts on ovaries
-
In boys, early arrival of:
- Facial hair
- Armpit hair
- Pubic hair
- Penis growth
- Increased masculinity
- Testicle enlargement
-
In both girls and boys, early arrival of:
- Body odor
- Acne
- Behavior changes
- Growth spurt
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.
Medications
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.
Psychological Support
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
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.
Ongoing Monitoring
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.
RESOURCES
The American Academy of Family Physicians
http://www.familydoctor.org/
American Academy of Pediatrics
http://www.healthychildren.org/
CANADIAN RESOURCES
Caring for Kids
http://www.caringforkids.cps.ca/
Health Canada
http://www.hc-sc.gc.ca/index%5Fe.html/
References
Blondell RD, Foster MB, Kamlesh CD. Disorders of puberty.
American Family Physician website. Available at:
http://www.aafp.org/afp/990700ap/209.html
. Accessed August 15, 2012.
Cesario SK, Hughes LA. Precocious puberty: a comprehensive review of literature.
J Ob Gyn Neonatal Nurs.
2007;36:263-274
DynaMed Editorial Team. Precocious puberty. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what.php
. Updated March 15, 2012. Accessed August 15, 2012.
Himes JH, Obarzanek E, Baranowski T, et al. Early sexual maturation, body composition, and obesity in African-American girls.
Obesity Research
. 2004;12:64S-72S.
Ibanez L, Valls C, Ong K, et al. Metformin therapy during puberty delays menarche, prolongs pubertal growth, and augments adult height: a randomized study in low birth weight girls with early-normal onset of puberty.
J Clin Endocrinol Metab
. 2006;91:2068-2073.
Papathanasiou A, Hadjiathanasiou C. Precocious puberty.
Ped Endocr Rev
. 2006;3:182-187.
Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls.
Pediatrics
. 2002;110:903-910.