Precocious Puberty (Early Puberty)
What is precocious puberty (early puberty)?
Abnormally early puberty is called precocious puberty and is characterized by the early development of sexual characteristics in girls before the age of 8 and in boys before the age of 9. Most children with the disorder grow fast at first, but also finish growing before reaching their full genetic height potential.
What causes precocious puberty?
Early puberty and sexual development may be caused by tumors or growths of the ovaries, adrenal glands, pituitary gland, or brain. Other causes may include central nervous system abnormalities, family history of the disease, or certain rare genetic syndromes. In most cases, no cause can be found for the disorder. Two types of precocious puberty include the following:
- Gonadotropin-dependent precocious puberty. Also known as central precocious puberty, this form of precocious puberty is the most common, affecting more girls than boys. The puberty is triggered by early secretion of gonadotropins (hormones produced by the brain to signal the beginning of puberty). In most cases, no specific cause is found.
- Gonadotropin-independent precocious puberty. This is a form of precocious puberty that is not triggered by the early release of gonadotropin hormones.
What are the symptoms of precocious puberty?
The following are the most common symptoms of precocious puberty. However, each child may experience symptoms differently. As in typical puberty, symptoms of precocious puberty include the onset of secondary sexual characteristics, including:
- Pubic and underarm hair
- Enlarging penis and testicles
- Pubic and underarm hair
- Facial hair
- Frequent spontaneous erections
- Production of sperm
- Development of acne
- Deepening of the voice
Other characteristics include:
- Typical moodiness associated with the hormonal changes
- Increased aggression
- Growth spurt (initially taller than peers but finish growing sooner)
Importantly, not everyone who shows these signs has true precocious puberty. Some patients may experience only one of the symptoms of early puberty. Premature thelarche is the early development of breast tissue that does not progress to full puberty and menstruation. With premature adrenarche, the body grows underarm and pubic hair earlier than is typical. Your provider will look at the whole picture for your child and may recommend a watchful approach in these cases.
How is precocious puberty diagnosed?
In addition to a complete medical history and physical examination of your child, diagnosis of precocious puberty may include:
- X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. A bone age x ray is an x ray of the hand that is a method for the doctors to understand the child’s growth window.
- Blood work. To measure levels of gonadotropins (LH and FSH), estradiol, testosterone, and/or thyroid hormones.
- Ultrasound (also called sonography) of the adrenal glands and gonads (ovaries and testes). This diagnostic imaging technique uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.
- Gonadotropin-stimulating hormone (GnRH) stimulation testing. This hormone, produced by the brain, stimulates the pituitary gland to release gonadotropins, which, in turn, stimulate the production of sex hormones from the gonads. This stimulation test will determine the form of precocious puberty (gonadotropin-dependent or gonadotropin-independent).
- Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
What are the medical options for precocious puberty?
Specific plans for precocious puberty will be determined by your child's healthcare provider based on:
- Your child's age, overall health, and medical history
- Extent of the condition
- Your child's tolerance for specific medicines, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
Should it be decided that medication is best for your child, the goal would be to stop, and possibly reverse, the onset of early puberty symptoms. The medical options will also depend on the type of precocious puberty and the underlying cause, if known.
What is the emotional effect of precocious puberty on a child?
Early puberty will cause a child's body to change much sooner than their peers. This sense of being different, coupled with the hormonal changes, may make a child feel self-conscious. Your child may feel uncomfortable about their sexual changes, as well. Helping your child cope with teasing from their peers, treating your child appropriately for their age and boosting your child's self-esteem are important steps to help your child adjust more appropriately.
Reviewed by: Marissa Kilberg, MD MSEd; Maria Vogiatzi, MD
Date: March 17, 2023