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Precocious Puberty (part 2 of 3)

Dr. Joel Steelman's series on precocious puberty (part 2)

The topic of precocious puberty is extremely broad, filling multiple pediatric textbook chapters. Causes of this unique condition are many and range from relatively common to quite rare. I’ve summarized terms that medical professionals use to define or describe the onset of puberty below.

  • Thelarche – development of breasts in girls
  • Adrenarche – development of pubic hair, armpit hair, body odor, and acne in both boys and girls
  • Central precocious puberty – activation of puberty coming from hormonal signals from the pituitary gland
  • Peripheral precocious puberty – changes of puberty not coming from the pituitary gland. This category is very broad and can include problems in the ovaries, testes, adrenal gland, or elsewhere.

The spectrums of symptoms experienced by a child with precocious puberty exist from mild, incomplete forms to much more serious, progressing forms. Mild patterns such as premature thelarche and premature adrenarche don’t typically require treatment. Periodic monitoring is necessary to verify that the course in these conditions remains reassuringly slow. In particular, there is growing concern that obesity combined with premature adrenarche may herald risk for health conditions such as polycystic ovary syndrome or type 2 diabetes in the future.

Sometimes, a diagnosis in precocious puberty is difficult to make, especially when an evaluation of the child falls within a ’gray’ area of medicine where both the severity and need for treatment are just not clear.

Spectrum of Precocious Puberty

The mental and physical impacts on a child with this condition depend on both the underlying cause, as well as the effects initiated by an early rise in hormone levels in the body. Some underlying causes of early puberty, such as tumors in the brain or adrenal gland, can be life-threatening.

Understandably, the body and emotional changes that accompany precocious puberty are distressing for many children and their families. Puberty is a strong determinant in the completion of height growth and when it occurs early, it will often stunt a child’s final adult height by fusing the growth plates in the bone closed.

Precocious puberty is much more common in girls vs boys, 3:1. Genetics also play a vital role in the timing of when hormone signals begin to progress. Not surprisingly, the timing of puberty – early vs late – can run in families

The majority of cases of true precocious puberty are central in origin, emanating from a premature rise in the hormone signals from the pituitary gland located in the brain. In girls, the majority of cases of central precocious puberty are termed idiopathic, meaning the condition arose spontaneously from an unknown or obscure cause.

Damage to the hypothalamus,or brain surrounding the pituitary gland, can lead to precocious puberty by disrupting the normal neurologic signals that regulate the pituitary gland and keep puberty in check. Severe head trauma, serious infections such as meningitis, or tumors in the brain are the more serious causes of central precocious puberty.

Causes of peripheral precocious puberty are numerous with McCune-Albright syndrome a particularly concerning one as this rare, genetic condition is characterized by the triad of benign bone tumors, precocious puberty, and a large, irregular skin café au lait spot.

Milder forms of congenital adrenal hyperplasia have features similar to premature adrenarche and can be difficult to evaluate. This condition fuels higher levels of androgens to be produced due to impairment in adrenal gland function. In contrast to premature adrenarche, puberty progresses more quickly, and bone growth plates mature rapidly. Tumors in the ovary or testes, estrogen-producing ovarian cysts, adrenal tumors are also worrisome.

Many parents wonder about the impact the environment may have on precocious puberty. Children can be exposed to testosterone and estrogen through a parent’s use of hormone replacement topical creams or though a product that is being used on them. It is critical to read labels as hormones are in many over the counter creams and supplements. Additionally, estrogen levels in a child can be affected by mom’s use of birth control pills or estrogen patches as well. Tea tree oil and lavender oil both have estrogen-like effects and soy contains phytoestrogen properties that can cause symptoms in susceptible individuals.

Hormones (both natural and synthetic versions) including growth hormone, estrogen, testosterone, and progesterone are used in animals to promote growth or enhance milk production. Currently, no large epidemiological studies have been done to conclusively determine if early puberty is associated with having consumed growth hormone treated foods.

We do know, primarily from animal research, that endocrine disrupting chemicals such as bisphenol A and phthalates interfere with the natural hormone system, impacting the production, release, and effects of natural hormones in the body. Both of these chemicals have been shown to cause early puberty in lab animals. Intense research attempting to determine if similar effects from these chemicals is present in humans is ongoing.

In part 3, I will write about diagnosis and treatment for precocious puberty.

About the author

As a self-described ‘techie,’ Joel Steelman, M.D., has a keen interest in the wise use of technology to improve medical care. Since 2001, he has helped implement electronic medical recordkeeping in two endocrine practices.

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