Precocious puberty

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Overview
Precocious puberty (Latin - pubertas praecox) is an unusually early onset of puberty, the process of sexual maturation that is triggered by the brain which usually begins in late childhood and results in reproductive maturity and completion of growth (Early puberty onset in children before the ages of 8 in girls and 9 in boys). Characteristics include early isolated pubic hair growth and early growth of female glandular tissue. Early puberty may be a variation of normal development, or may be a result of a disease or abnormal hormone exposure. In some contexts, the term is used more broadly to describe the early appearance of any of the physical features of puberty even if the complete, brain-directed process is not occurring.

Types and causes
Early pubic hair, breast, or genital development may result from natural early maturation or from several other conditions.


 * Early puberty which is natural in every way except age is termed idiopathic central precocious puberty. It may be partial or transient. Central puberty can also occur prematurely if the inhibitory system of the brain is damaged, or a hypothalamic hamartoma produces pulsatile gonadotropin-releasing hormone (GnRH).


 * Secondary sexual development induced by sex steroids from other abnormal sources (gonadal or adrenal tumors, congenital adrenal hyperplasia, etc.) is referred to as peripheral precocious puberty or precocious pseudopuberty.

Clinical significance
Early sexual development deserves evaluation because it may:
 * 1) induce early bone maturation and reduce eventual adult height,
 * 2) cause significant social problems (such as the child becoming an object of sexual attraction, even pedophilia) or
 * 3) indicate the presence of a tumor or other serious problem.

Central precocious puberty can be caused by intracranial neoplasm, infection, trauma, hydrocephalus, and Angelman syndrome.

High levels of beta-hCG in serum and cerebrospinal fluid observed in a 9-year old boy suggest a pineal gland tumor. The tumor is called a chronic gonadotropin secreting pineal tumor. Radiography and chemotherapy reduced tumor and beta-hCG levels normalized. "Central precocious puberty (CPP) was reported in some patients with suprasellar arachnoid cysts(SAC) [3], and SCFE occurs in patients with CPP because of rapid growth and changes of growth hormone secretion."(European Journal of Pediatrics;March2005,Vol.164 Issue 3,p173-174,2p,1 gragh)

Bones can be considered older in individuals with early puberty beyond actual age of individual. Early puberty is marked by growth hormone problems resulting from various brain disorders.

Measures
Studies indicate that breast development in girls and pubic hair in girls and boys is starting earlier than in previous generations. As a result, "early puberty" in children as young as 9 and 10 is no longer considered abnormal, although it may be upsetting to parents and can increase the risk of alcohol and drug use as well as other social problems.

No single age limit reliably separates normal from abnormal processes in children today, but the following age thresholds for evaluation will minimize the risk of missing a significant medical problem:
 * Pubic hair or genital enlargement in boys with onset before 9 years.
 * Breast development in boys before appearance of pubic hair and testicular enlargement.
 * Pubic hair before 8 or breast development in girls with onset before 7 years.
 * Menstruation in girls before 10 years.

Suggested causes: Environmental estrogens, sedentary lifestyle.

Differential Diagnosis

 * After Meningitis
 * Brain Tumors
 * Endogenous sexual steroids
 * Exogenic sexual steroids
 * Inflammation
 * Internal hydrocephalus
 * McCune-Allbright Syndrome
 * Pellizzi's Syndrome
 * Radiation
 * Recurrent seizures
 * Tumors

Other notes
Medical evaluation is sometimes necessary to recognize the few children with serious conditions from the majority who have entered puberty early but are still medically normal.

Girls who are obese are more likely to physically mature earlier. Precocious puberty can make a child able to conceive when very young. Both sexes have become parents before age 10. The youngest mother on record is Lina Medina, who gave birth at the age of 5 years, 7 months and 21 days. An 8 year old boy had early puberty caused by a malignant intracranial germ cell tumor.

The role of the pineal gland in reproduction of other species of vertebrate suggest that the pineal gland does have significance in development and function of human reproductive axis. In a study using neonatal melatonin on rats, results suggest that elevated melatonin could be responsible for some cases of early puberty.