pediatrics
Precocious Puberty
Etiology of Precocious Puberty
In most affected girls, a specific cause cannot be identified. In the absence of specific symptoms or signs of central nervous system disease, the probability of an intracranial abnormality depends on younger age of onset of puberty (< 4 years in girls) and sex of the child (more common among boys). Overall, affected boys are more likely (up to 60%) to have an identifiable underlying lesion. Such lesions include Overview of Intracranial Tumors , especially of the hypothalamus or pineal gland region, including hamartomas, The etiology of GnRH-independent precocious puberty depends on the predominant sex hormone effect (estrogenic or androgenic), and physical changes are often markedly discordant from normal pubertal development. Estrogenic effects are most commonly caused by follicular ovarian cysts; other causes include granulosa-theca cell tumors and McCune-Albright syndrome (a triad of follicular cysts, polyostotic fibrous dysplasia, and café-au-lait spots). Adrenal enzyme defects, specifically Overview of Congenital Adrenal Hyperplasia , are the most common pathologic form of androgen excess in children of either sex. Additional causes of GnRH-independent precocious puberty in boys include familial male gonadotropin-independent precocity (due to an activating mutation of the gene for luteinizing hormone [LH] receptors), 