What is Precocious Puberty? Know Its Causes, Symptoms, Treatment and Risks

Puberty is when a child enters the adulthood phase with physical developments along with sexual growth. Boys start to get moustache and beard whereas girls experience breast development. This normally happens around 10-14 years age in girls and 12-16 years age in boys but some children get puberty much earlier. Precocious puberty means a condition wherein signs of sexual maturity among boys and girls appear much earlier than 8-9 years, which is the average age of puberty. Approximately 1 out of 1500 children suffer from precocious puberty. Let us know more about this condition from Dr. Anjeli Misra, MD- Path, Founder and Director of Lifeline laboratory.

Precocious Puberty Types 

There are two types of precocious puberty:

Central Precocious Puberty

This is the more common type of precocious puberty and quite similar to common puberty, characterized by early signs of secondary characteristics of sexual maturity (appearance of acne, pubic and underarm hair, development of breasts, changes in voice among boys, facial hair, height gain, etc.).

Peripheral Precocious Puberty

This type, known as ‘pseudopuberty’, due to the over-secretion of estrogen and testosterone (sex hormones), despite the absence of stimulation caused by the release of gonadotropins from the pituitary gland, which is characteristic of normal puberty.

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Causes & Symptoms

Family history and genetic make-up may be a cause of early puberty. Studies have established that if a woman starts menstruating early (before 10-11 years), then her daughter too would also start menstruating early. Other underlying causes could be genetic disorders or gene mutations.

• Hormonal imbalance: Sexual development, sexual maturity, sexual characteristics and sexual function are determined by the secretion of hormones (called gonadotropins) in the pituitary and adrenal glands. Inexplicably, sometimes, gonadotropins trigger the over-secretion of sex hormones. Testosterone is responsible for facial, underarm and pubic hair, height gain, acne, and voice thickening in boys, and estrogen is responsible for breast development in girls.
• Underactive thyroid function or Hypothyroidism: This could also be one of the causes for imbalance in the secretion of sex hormones, resulting in early onset of puberty.  
• Obesity: Excess weight and obesity is linked to early onset of menstruation in girls and early puberty in boys. 
• Gender: Girls are 10 times more likely to attain precocious puberty, than boys. 
• Pre-existing medical conditions: Ovarian cysts in girls, tumours, congenital adrenal hyperplasia, exposure to radiation treatment, brain injury, infection and inflammation are also seen to act as triggers for precocious puberty.

Complications

Short height: A sudden initial spurt in height (as compared to peers) is observed in cases of precocious puberty – this initial spurt leads to faster maturity of bones which stop growing after this sudden initial growth.  This results in shorter average height (as compared to peers) in most cases.   

Emotional & psychological issues: Increased tendency towards self comparison with peers, self-esteem issues, depression and substance abuse, are observed among cases of precocious puberty. 

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Precocious Puberty Treatment

Physical examination and screening by a paediatric endocrinologist for physical characteristics that appear with early onset of puberty and to determine the underlying cause of precocious puberty. The doctor would recommend hormonal screening and imaging tests to decide a course of treatment.

• Blood test GnRH (Gonadotropin releasing Hormone) stimulation test is conducted to determine the patient’s hormone response by carrying out a series of tests on the patient over a period of time.
• Based on the outcome of this test, doctors may recommend GnRH Analog Therapy as treatment as required, to decelerate the process of early onset of puberty. This treatment continues up to the time the patient has reached a suitable age for attaining puberty.
• Thyroid profile is done to screen for hypothyroidism.
• MRI (Magnetic Resonance Imaging) is carried out to rule out any abnormalities in the patient’s brain function.

Doctors may also recommend counselling to help the child to overcome any self esteem, depression, or emotional anxiety issues in the child patient, arising out of self-comparison with peers.

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