Understanding Central Precocious Puberty : Causes, Symptoms, and Treatment Options

Puberty can be a difficult time for the adolescent as well as parents. However, for some, having early onset of puberty causes more emotional and physical problems.

Central precocious puberty is a condition where the child experiences puberty at a very early age than is normal. The reason for this occurring is signal transmission to the hypothalamus by the brain to start producing gonadotropin-releasing hormone (GnRH), much earlier than is normal.

The exact cause of central precocious puberty is not clear. According to the AAFP, central precocious puberty is thought to occur from health factors that develop in the brain, such as a trauma, brain tumor, radiation, infections or other problems with the brain ⁽¹⁾. If you see the symptoms of early puberty in your child, then you need to consult the child’s pediatrician regarding cause and treatment.

Central precocious puberty occurs more commonly in girls when compared to the boys. According to the AAFP or American Academy of Family Physicians, the symptoms of puberty in a girl aged under 8 years old or a boy younger than 9 years may indicate central precocious puberty ⁽¹⁾. Some of the symptoms of Central precocious puberty are:

• The enlargement of the penis or testicles in boys.
• Deepening of the voice in boys.
• Start of menstruation and development of breasts in girls.
• Fast growth of the child.
• Development of underarm or pubic hair.
• Having acne.

The normal age of puberty in girls is between ages 8 and 13 and in boys is between ages 9 and 14. In case of premature development, medical consultation should be sought where the doctor can diagnose central precocious puberty and prescribe treatment accordingly.

Having premature onset of puberty greatly affects a child’s physical as well as emotional health. The child going through central precocious puberty experiences social and psychological concerns linked with early puberty. According to the National Institute of Child Health and Human Development, such children may not be able to attain their full height because their growth stopped too soon ⁽²⁾.

However, not every child suffering from central precocious puberty needs medical intervention. According to a 2018 research, the aim of treatment when recommended by the doctor consists of the following ⁽³⁾:

• Treatment consists of treating the underlying cause of central precocious puberty.
• Stopping the rapid bone maturation and growth in the child.
• Trying to slow down more sexual development or maturity.
• Trying to preserve the potential to reach the maximum height by the child.
• Reducing the psychological and emotional impact on the child.

Treatment for central precocious puberty is done by a pediatrician and the patient can also be referred to a pediatric endocrinologist who is a specialist in dealing with hormonal and growth disorders in children.

A 2019 review shows that the main line of treatment for central precocious puberty is GnRHa, which are long-acting GnRH agonists ⁽⁴⁾. These consist of medications, such as triptorelin or leuprolide acetate.

Previously these treatments for central precocious puberty were done on a monthly basis. However, in 2011, the Food and Drug Administration approved a type of depot leuprolide, which is administered every three months for treatment of central precocious puberty. In the year 2017, approval was given by the FDA for a type of depot triptorelin which is given every six months ⁽⁵⁾.

Thanks to these new treatments, the families have more options and are able to increase the gap between the treatments.

One more treatment option for central precocious puberty is a histrelin implant, which is a GnRH agonist that is inserted in the upper arm ⁽⁶⁾. This is also GnRHa just like other treatments for central precocious puberty.

The primary benefit of a histrelin implant is that its effectiveness can be seen for a year ⁽⁶⁾ However, minor surgery is needed to place this device in the upper arm. The pros and cons of this surgical intervention will be discussed with the parent of the child. If the cause of the central precocious puberty is diagnosed, then treatment is recommended accordingly to halt the early development of puberty.

The treatment for central precocious puberty mainly consists of GnRHa treatments and is usually considered safe. One of common side effect of this Central precocious puberty treatment is a mild reaction where the injection is given. In rare cases, a sterile abscess can develop in children at the site of injection if the medicine is not completely absorbed by the body.

A small study done in 2006 suggests that GnRHa treatment can cause declination of growth velocity, more so if the child has advanced bone age.⁽⁷⁾ By growth velocity it means the changes in the weight and height of the child and how they develop with time. Due to this, oxandrolone or supplementary treatment of growth hormones can be recommended by the doctor.

Not all children suffering from central precocious puberty need treatment, especially if they have reached a certain age when the diagnosis of early signs of puberty is made.

According to a review done in 2019 of scientific literature a six-month observation period is recommended after the initial signs of puberty are seen; however, not if the puberty has reached an advanced stage.⁽⁸⁾ Nonetheless other experts also recommend that early intervention can be better for delaying the growth of height.

One of the important reasons to seek treatment for central precocious puberty is the desire to reduce or avoid the negative psychological consequences which are associated with early puberty. However, caution should be used when this is the only reason for seeking central precocious puberty treatment, as more research is needed when it comes to the psychological effects of central precocious puberty.⁽⁹⁾

Discussing with the child’s doctor is the best way to find out the right course of action, such as the right treatment for the child and when and if to start the treatment.

Central precocious puberty is not a fatal or life threatening condition, however it can cause some serious concerns in children like:

• Emotional and social struggles/difficulties.
• Premature/early sexual maturation.
• A lesser adult height.

If early signs of puberty are observed in a boy under the age of 9, or a girl below the age of 8, then it is important to seek medical consultation.

The pediatrician will perform a complete physical exam and will put forward different treatment options, which can help in managing the signs of early puberty and can help in slowing the puberty until the right age if needed.

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