Understanding Precocious Puberty : Causes, Symptoms, and Management

Also known as early onset puberty, precocious puberty is where the child, either girl or boy, matures sexually early than the normal age. The age of precocious puberty is age 8 in girls and in boys is before the age of 9.⁽¹⁾

Precocious puberty is not common and about 1 in 5,000 to 10,000 children are affected by this condition.⁽²⁾

Some of the signs and symptoms of precocious puberty in girls and boys are:⁽³⁾

• Development of underarm and pubic hair.
• A fast growth spurt.
• Adult body odor.

Signs of precocious puberty specific to girls are:⁽³⁾

• Breast development.
• Start of menstruation.

Signs of precocious puberty specific to boys are:⁽³⁾

• Growth of facial hair.
• Enlarged penis and testicles.
• Spontaneous erections and ejaculations.
• Deepening of the voice.

The two primary forms of this condition are: central precocious puberty and peripheral precocious puberty.⁽³⁾ The causes of both these conditions are different; however, the fundamental changes they cause in the body are similar.

Central Precocious Puberty: This kind of precocious puberty occurs when there is secretion of gonadotropins by the brain at an extremely young age. These are the hormones which are released by the pituitary gland and they signal the gonads that are ovaries in girls and testicles in boys to start producing sex hormones that cause the physical changes related to puberty.

The exact cause of central precocious puberty is not clear. Most of the children having this condition do not suffer from other serious medical problems or any other underlying health issues, which can cause precocious puberty.

However, in some cases, there are some conditions which are associated with central precocious puberty and these are:⁽³⁾

• Injury to the spinal cord or brain.
• Spinal or brain tumor.
• Accumulation of fluid in the brain at the time of birth.
• Peripheral precocious puberty.

Peripheral Precocious Puberty (PPP) is not as common as Central Precocious Puberty and this type of precocious puberty is not stimulated by the premature release of gonadotropins by the pituitary gland. Rather, the cause of peripheral precocious puberty is early production of the hormones, estrogen and androgen in other regions of the body and this is the reason why it is also called as gonadotropin independent precocious puberty (GIPP).

The early production of estrogen and androgen can occur as a result of other underlying problems with: ovaries, testicles, pituitary gland and adrenal glands.

Some of the potential causes of Peripheral Precocious Puberty are: Ovarian cysts in girls, tumors in the adrenal or pituitary glands and testicular tumors in boys.

McCune-Albright syndrome is a rare genetic disorder which causes problems with production of hormones, bone health and skin color.

Other sub-types of precocious puberty are:

Premature thelarche where there is mild development of breasts in girls.⁽⁴⁾ This can be temporary and gradually disappears until the girl attains normal puberty.

Premature adrenarche is the other type of precocious puberty where there is secretion of androgen by the adrenal glands at a very young age and causes some pubic hair growth and development of adult body odor in boys.⁽⁵⁾ However, except these, there are no other characteristics of puberty seen until the appropriate age of puberty.

Treatment is not required for these two types of precocious puberty.

Girls are more affected by precocious puberty than boys. African-American children are also at increased risk for this condition.

Having a family history of this condition increases the risk for precocious puberty.

Experts are learning more about the genetic risk factors, such as a kisspeptin gene (KISS1) mutation and its receptor (KISS1R). Another gene which is MKRN3 that is passed from the father’s side can also play a role in causing precocious puberty.⁽⁹⁾

Some of the other factors which increase the risk of precocious puberty are:⁽⁶⁾

• Obesity or being overweight.⁽⁸⁾
• Radiation treatment of the spinal cord or brain for leukemia, tumors and similar conditions.
• Exposure to or ingestion of products which have hormones, such as estrogen or testosterone in them or the use of hormone creams/ointments and birth control pills.

Precocious puberty causes the child to be taller than their peers initially.⁽⁸⁾ However, as their growth plates get sealed at a younger age, these kids will be commonly shorter than the average child their age in adulthood.

There is also the matter of becoming self-conscious and feeling awkward as the physical changes of the precocious puberty occur. Children go through emotional and social turmoil and can suffer from depression, low self-esteem and substance misuse later on.

The child’s medical history and family medical history is reviewed by the pediatrician. A physical exam of the child is done. An x-ray can be taken to assess the “age” of the bones of the child. Signs which show that the bones are growing faster than is normal help in confirming or excluding the diagnosis.⁽³⁾

Blood tests are done, such as gonadotropin-releasing hormone (Gn-RH) stimulation test and other tests to check the levels of other hormones, like progesterone in girls and testosterone in boys to confirm the diagnosis of precocious puberty.

Magnetic resonance imaging (MRI) scan can also be done to look for problems with the pituitary gland.

In children going through central precocious puberty, there will be an increase in other hormone levels due to Gn-RH. However, the hormone levels will not change in children going through peripheral precocious puberty.

If the child has mild central precocious puberty or if it occurs close to the actual age of puberty, then treatment is not needed. For other cases, treatment will depend on the form of precocious puberty the child is having.⁽³⁾

Treatment of Central Precocious Puberty: Treatment of CPP is done to halt the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by the pituitary gland. Medications used for treating precocious puberty are known as GnRH agonist, which blocks the gonadal activity of the gland.⁽³⁾ This is often given in the form of injection about every one to three months or it can be placed as an implant which then slowly releases the medicine over a period of one year.

Along with slowing the process of puberty, this treatment can allow the child to reach their potential height which would not have been possible without the treatment. About 16 months or one-and-a-half year later normal puberty starts and the treatment is stopped.

Treatment of Peripheral Precocious Puberty: As PPP is caused by some underlying cause like tumor, so the treatment consists of treating any underlying condition so the early onset of puberty can be stopped. Medications which stop the premature production of testosterone and estrogen can also be prescribed in treating Peripheral Precocious Puberty.

Many of the risk factors for precocious puberty are associated with race, gender and family history. Other causes which contribute to precocious puberty are mostly unavoidable, so there is only so much one can do to prevent this condition.

Some of the things which can be done to prevent precocious puberty are making sure that your child’s weight is in a healthy range which will helps in cutting down the risk of precocious puberty and also prevent other weight related conditions such as type 2 diabetes. One should also avoid giving the child dietary supplements or prescription hormone medications or anything that has testosterone or estrogen in it.

It is normal for your child to be confused and ask a lot of questions in regards to what is happening within and to their body. Other children their age can bully or mock them for being different or growing differently. Always listen to what your child is saying and answer their questions honestly and sensitively. Explain to them that every child experiences puberty in a different manner and at different time. There are some who start early and some kids who experience puberty much later in life. It is important to make them understand that everyone will experience all these changes to their body at some point in their life.

It is also important to remember that precocious puberty also causes early onset of sexual feelings. Try to understand your child’s confusion and curiosity about these changes which occur as a result of premature production of sex hormones.

It is also important to set clear boundaries regarding behaviors and educate your child about sexual awareness and priorities, values and healthy choices.

Always treat your child as normally as possible and encourage them so their self esteem is increased. Also encourage your child in participating in extracurricular activities, which will help them keep engaged and happy and help with their self-confidence.

Do not hesitate to seek counseling for your child to cope with the changes of precocious puberty.  Your child may not be comfortable talking to you about certain things and can open up to a therapist.

Precocious puberty does not cause any long-term health issues. One of the lasting effects of precocious puberty is having shorter than average height.⁽¹⁰⁾ With counseling and proper treatment, children going through precocious puberty can easily lead a happy childhood and healthy adolescence and adulthood.

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Also Read:

• Understanding Central Precocious Puberty : Causes, Symptoms, and Treatment Options
• Early Onset of Puberty : Causes, Signs, and Implications of Precocious Puberty