children s health issues
Early Puberty
Precocious Puberty
In precocious puberty, a child's body begins changing into an adult's body earlier than anticipated. The definition of precocious puberty has traditionally been before age 8 in girls or age 9 in boys. Precocious puberty is more common among some families. There are three types of precocious puberty: Central precocious puberty Peripheral precocious puberty Incomplete puberty The causes and symptoms differ between the three types. This type of precocious puberty is more common overall and is 5 to 10 times more frequent in girls. Puberty in this type is triggered by the early release of certain sex hormones (gonadotropins) from the pituitary gland. These hormones cause the ovaries or testes (the sex glands) to mature and enlarge. Once mature, the sex glands begin secreting other sex hormones, such asestrogenortestosterone, which triggers puberty. Physical changes are typically those of normal puberty for a child of that sex, except they begin at an earlier age. Boys show enlargement of the testes, lengthening of the penis, and development of facial, underarm, and pubic hair, and they take on a masculine appearance. Girls develop breasts and pubic hair and underarm hair and may begin to menstruate. In both sexes, there is a growth spurt that leads to a rapid height increase. However, unlike in normal puberty, the rapid height increase in precocious puberty ends early so children are shorter as adults than would be expected. Doctors do not usually find a cause for the early hormone release, particularly in girls, but sometimes it is caused by a tumor or other abnormality in the brain, typically in the pituitary gland or the hypothalamus (the region of the brain that controls the pituitary gland). Neurofibromatosis (a disorder where many fleshy growths of nerve tissue grow under the skin and in other parts of the body) and a few other rare disorders also have been linked to central precocious puberty. Severe, untreated This type of precocious puberty is much less common. In peripheral precocious puberty, the release ofestrogenortestosterone(andtestosterone-like hormones called androgens) is not stimulated by gonadotropins from the pituitary gland. Instead, high levels of androgens orestrogenare produced by a tumor or other abnormality in the adrenal gland or in an immature testis or ovary. These hormones do not cause the testes or ovaries themselves to mature but do trigger the development of secondary sex characteristics. Because boys and girls with peripheral precocious puberty may each produceestrogenor androgen, the physical changes of puberty depend on the hormone produced rather than the child's sex. Thus, tumors and abnormalities that produceestrogenresult in growth of breast tissue in boys and girls, whereas those that produce androgens result in growth of pubic and underarm hair, adult body odor, and acne in boys and girls and, in boys, enlargement of the penis (but not the testes). Some children prematurely develop only a few signs of puberty. Typically they have premature breast development (thelarche) or premature pubic hair development (adrenarche) without any of the other changes of puberty such as growth of the testes or ovaries, menstruation, or a growth spurt. Some girls have breast development during the first 2 years of life, but they do not have elevated hormone levels. Children with early pubic hair development (typically between 6 years and 8 years of age) often have adult-like body odor and acne. Changes progress slowly. These early physical changes are not caused by a disorder, and only a few children go on to develop actual precocious puberty. Early pubic hair development occurs because the adrenal gland increases the level of androgens it produces. However, levels of gonadotropins and estrogens are not increased with early pubic hair development. 