KidsMD Health Topics

Precocious (Early) Puberty

  • Overview

    "Sometimes, the pituitary begins signaling the ovaries and testes to make sex hormones earlier than it should. It can be that simple -- the switch just gets turned on too soon."

    Diane Stafford, MD, assistant clinical director, Children's Division of Endocrinology

    When a child enters puberty (the process of becoming sexual mature) too early, it’s called precocious puberty, or early puberty. Children experiencing the condition develop early sexual characteristics; in girls this means before age 8, and in boys, this means before age 9.

    • Most children with the disorder grow faster than their peers at first, but finish growing before reaching their anticipated height.
    ?• Children with this disorder may have psychosocial difficulties as they may not be emotionally prepared for the physical changes of puberty and may feel self-conscious about these changes.
    ?• There’s every reason to be optimistic. With proper treatment and care, most children with precocious puberty will ultimately experience a normal and happy adolescence.

    • The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of puberty. At Children’s, we often use synthetic luteinizing-hormone-releasing hormone (LHRH).

    How Children’s Hospital Boston approaches early puberty?

    Our Division of Endocrinology is one of the world's leading centers dedicated to caring for children and adolescents with endocrine disorders, including early puberty. Caring for more than 7,000 patients each year, our division is one of the largest pediatric endocrinology practices in the country.

    Our team is sensitive to the physical and emotional challenges that come along with entering puberty early, and our team is here to help. It’s perfectly normal for a child to feel different than his peers when his friends have gone through puberty and he hasn’t. But with treatment and care, most children will go on to have a normal and happy adolescence and healthy adulthood.

    Children's has been ranked second in Endocrinology
    Children's has been ranked second in Endocrinology in the U.S.News Media Group's 2009 edition of American's Best Children's Hospitals featured in the August issue of U.S. News & World Report.

    Reviewed by Diane Stafford, MD
    © Children’s Hospital Boston; posted in 2011

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  • In-Depth

    At Children’s Hospital Boston, we understand that you may have a lot of questions when your child is diagnosed with precocious puberty. How can I help my child feel less self-conscious about being different? How will early puberty affect my child long-term? Are there any serious side-effects to treatment? We’ve tried to provide some answers to those questions on this site and our doctors can explain your child’s condition to you fully.

    There are two types of precocious puberty:

    central precocious puberty (gonadotropin-dependent) is the most common, affecting more girls than boys. It’s triggered by the premature secretion of gonadotropins from the brain.

    peripheral precocious puberty (gonadotropin-independent) is not triggered by the early release of gonadotropin hormones in the brain, but by androgen and estrogen production from other parts of the body.

    What are gonadotropins?

    Gonadotropins are hormones released by the pituitary gland in the brain that are responsible for stimulating the gonads (ovaries and testes) to produce sex hormones. The sex hormones, in turn, cause sexual development and maturation. In other words, we can think of gonadotropins as the hormones that are ultimately responsible for puberty.

    What causes central precocious puberty?

    In girls, the cause of precocious puberty 90 to 95 percent of the time is idiopathic, or unknown, meaning doctors don’t know for certain why it happens. Boys are more likely to have an underlying identifiable cause.

    Early puberty and sexual development may be caused by:

    • central nervous system abnormalities
    • family history of the disorder
    • certain rare genetic syndromes
    • tumors of the pituitary gland or brain


    What causes peripheral precocious puberty?

    Peripheral precocious puberty may be caused by:

    • certain rare genetic syndromes
    • tumors of the ovary or testis
    • other tumors that secrete human chorionic gonadotropin
    • disorders of the adrenal gland
    • severe hypothyroidism

    What are the signs of precocious puberty?

    Although each child may experience signs of precocious puberty differently, they are generally the same as the signs of regular puberty, including:

    Girls:

    • increasing height/growth spurt
    • breast development
    • menstruation or vaginal bleeding

    Boys:

    • enlarging testicles and penis
    • pubic and underarm hair
    • facial hair
    • spontaneous erections and/or ejaculations
    • development of acne
    • deepening of the voice

    When your child is diagnosed with precocious puberty, you may feel overwhelmed with information. It can be easy to lose track of the questions that occur to you.

    Lots of parents find it helpful to jot down questions as they arise – that way, when you talk to your child’s doctors, you can be sure that all of your concerns are addressed. If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

    Here are some questions to get you started:

    • Is there a known cause for my child's symptoms?
    • Is there something you can do to slow the process, or stop it altogether?
    • If so, will it be possible to resume puberty again when my child is ready?
    • Are there any long-term risks to treatment?
    • How should I talk to my child about her condition?

    Q: What causes precocious puberty?
    A: In girls, in 90 to 95 percent of cases, the cause of precocious puberty is idiopathic, or unknown, meaning doctors don’t know for certain why it happens. An underlying cause is usually found in boys.

    Q: How is precocious puberty treated?
    A: The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of puberty. Treatment will also depend on the type of precocious puberty your child has and the underlying cause, if known.

    When treating central precocious puberty at Children’s Hospital Boston, we often use synthetic luteinizing-hormone-releasing hormone (LHRH). This hormone appears to stop sexual maturation brought on by the disorder by stopping the pituitary gland from releasing gonadotropin.

    Treatment of peripheral precocious puberty depends on the cause for the increase in estrogen or testosterone levels in the body.

    Q: How will precocious puberty affect my child?
    A: In addition to showing physical signs of early puberty, children with precocious puberty often have low self-esteem linked to the feeling of being different than their peers. Other people, including children and adults, may assume children with precocious puberty are older than they actually are and may expect them to behave beyond their maturity level. Encouraging your child to be open about her feelings will help immensely.

    Q: Will my child be OK?
    A: There’s every reason to be optimistic. With proper treatment and care, most children with precocious puberty will ultimately experience a normal and happy adolescence.

    Coping and support?

    Many parents ask, ‘How will early puberty affect my child emotionally?’ The short answer is that early puberty will cause your child's body to change much sooner than her peers’ bodies, and this sense of being different, coupled with the hormonal change-induced emotional mood swings, may make your child feel self-conscious. Your child may feel uncomfortable about these sexual changes as well.

    Helping your child cope with teasing from her peers is important, as is treating your child age-appropriately and taking steps to boost his or her self-esteem. At Children’s Hospital Boston, we know what you’re going through, and we’re here to help guide you through the process.

    We also have a number of other resources to help you and your family.

    Patient education
    From the first office visit, our physicians and nurses will be on hand to walk you through your child’s treatment and help answer any questions you may have. They will also reach out to you by phone, continuing the care and support you received while at Children’s.

    Parent to parent
    Want to talk with someone whose child has been treated for precocious puberty? We can often put you in touch with other families who have been through the same treatments that you and your child are facing, and share their experience.

    Social work and mental health professionals
    Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child’s diagnosis, stresses relating to coping with illness and dealing with financial difficulties.

    On our For Patients and Families site, you can read all you need to know about:

    • getting to Children’s
    • accommodations
    • navigating the hospital experience
    • resources that are available for your family
    Center for Young Women's Health and Center for Young Men's Health
    Why are my friendships changing? How can I convince my parents that being a vegetarian is healthy and right for me? What types of birth control are available to me, and how do I use them? Young men and young women may have some concerns specific to their gender, and some that they share. At Children’s, the Center for Young Women’s Health and Center for Young Men’s Heath offer the latest general and gender-specific information about issues including fitness and nutrition, sexuality and health, health and development and emotional health.

    Treatment and care

    The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of your child’s early puberty. Treatment will also depend on the type of precocious puberty and the underlying cause, if it’s known.

    Treating central precocious puberty
    When treating children with central precocious puberty, we often use synthetic luteinizing-hormone-releasing hormone (LHRH). This hormone appears to stop sexual maturation brought on by the disorder by stopping the pituitary gland from releasing gonadotropin.

    LHRH can be given as an injection once per month or via a small implant placed surgically under the skin, which is effective for one year. Your child’s doctor will help determine which form of therapy would be more appropriate for your child.

    The duration of each child’s treatment varies and is determined individually, but children are usually treated until they reach an age at which progression through puberty would be appropriate. Once medication is stopped, children will progress through puberty normally, though the pace may be faster than average.

    Treatment for central precocious puberty has no known long-term side effects. Short-term side effects can include pain or irritation at injection sites or difficulties with medications given during implant insertion.

    Treating peripheral precocious puberty
    Treatment for peripheral precocious puberty depends on what’s causing excess estrogen or androgen production. Options include tumor removal, blocking the actions of estrogen or androgen on the body, or treatment of hypothyroidism with replacement thyroid hormone.

  • Tests

    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 which uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film. A bone x-ray may be performed to determine bone age.
    • measurement of important hormones including gonadotropins (LH and FSH), estradiol, testosterone and/or thyroid hormones
    • ultrasound (also called sonography) of the adrenal glands and gonads (ovaries and testes) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. These tests are used to view internal organs as they function, and to assess blood flow through various vessels.
    • gonadotropin-stimulating hormone (GnRH) stimulation test - This test can determine whether your child's precocious puberty is 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 treatments are available for precocious puberty?

    The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of puberty. Treatment will also depend on the type of precocious puberty and the underlying cause, if known.

    New developments in treatments for precocious puberty have led to the successful use of synthetic luteinizing-releasing hormone (LHRH). This hormone appears to stop sexual maturation brought on by the disorder by stopping the pituitary gland from releasing gonadotropin.

    What is the emotional effect of precocious puberty on a child?

    Early puberty will cause your child's body to change much sooner than his peers. This sense of being different, coupled with the hormonal change-induced emotional mood swings, may make him feel self-conscious. Your child may feel uncomfortable about his sexual changes, as well.

    Helping your child cope with teasing from his peers, treating your child appropriately for his age, and boosting his self-esteem are important steps to help your child adjust well.

  • Research & Innovation

    Boston Children's Hospital's Division of Endocrinology operates one of the nation's most extensive research programs focused on pediatric endocrine disorders. With more than 50 basic science and clinical researchers, we are attempting to unravel the genetic and biochemical underpinnings of the endocrine system.

    When it comes to puberty in general and what controls it, there’s a lot that doctors don’t fully understand. Nobody knows for sure what signals the secretion of gonadotropins, or what specific things need to be “turned on” to ignite puberty.

    Researcher Yee-Ming Chan, MD, is studying kisspeptin, a neuropeptide hormone that’s presumed to be involved in the stimulation of pubertal development. Understanding kisspeptin and the search for other factors that control the onset of puberty will allow doctors to answer basic questions about the control of puberty as well as develop better methods of diagnosis and treatment.
     
    Diane Stafford, MD, and several of her Children’s colleagues are currently working on a study to definitively diagnose who is in puberty and who isn’t by using something called leuprolide stimulation testing. Their research involves analyzing test data from patients they’ve followed over the years and comparing who has progressed into puberty and who has proven to be “a false positive” and did not progress into puberty. The results could provide much-needed insight into which patients require treatment for precocious puberty and which do not.

    Children’s is known for pioneering some of the most effective diagnostic tools, therapies and preventive approaches in matters relating to endocrinological problems. A significant part of our success comes from our commitment to research—and to advancing the frontiers of pediatric health care by conducting clinical trials.

    Children’s coordinates hundreds of clinical trials at any given time. Clinical trials are studies that may involve:

    • evaluating the effectiveness of a new drug therapy
    • testing a new diagnostic procedure or device
    • examining a new treatment method for a particular condition
    • taking a closer look at the causes and progression of specific diseases


    Taking part in a clinical trial at Children’s is entirely voluntary. Our team will be sure to fully address any questions you may have, and you may remove your child from the medical study at any time.

    Search current and upcoming clinical trials at Children’s.
                
    Search the National Institutes of Health’s list of clinical trials taking place around the world.

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