Precocious puberty
Normal puberty involves both physical body changes and psychological and emotional changes and should begin after the age of 8 years for girls and after the age of 9 years for boys.
How do we know that puberty has started?
The key sign that marks the onset of puberty in girls is the appearance of the breast bud (known as ‘telarche’) and in boys it is the increase in testicular volume (above 4ml).
What other signs are usually present?
This key sign is usually accompanied in both sexes by accelerated growth (pubertal growth spurt), the appearance of pubic and armpit hair (‘pubarche and axillarche’), body odour, the appearance of acne-like facial pimples, mood swings, voice changes in boys… and in girls finally, about two years after the onset of the breast bud, the onset of menstruation. All these signs appear as a consequence of the activation of sex hormones.
So what is precocious puberty and what does it involve?
It is a pathology that occurs more frequently in females than in males and is when the mammary bud appears in girls before the age of 8 years or when an increase in testicular volume (over 4 ml) appears in boys before the age of 9 years, regardless of whether or not other accompanying signs appear.
Precocious puberty implies that pubertal development begins and ends earlier than normal. This has not only a psychological impact due to physical changes (especially in girls due to the onset of menstruation) but also in some cases has an impact on final height, as patients may stop growing earlier than they should without reaching their full height potential.
What causes precocious puberty?
In most cases, especially in girls, precocious puberty occurs because the brain activates hormonal signals earlier than it should, without any other underlying medical problem being found. Often, especially in girls, there is a family history of precocious puberty (mother, aunts, grandmothers). Much less often, precocious puberty is due to more serious problems, such as an intracranial tumour or a thyroid problem.
What should we do if we suspect that our son/daughter may have precocious puberty?
In these cases it is advisable to go to the paediatrician for an initial assessment and request an assessment by the paediatric endocrinology department.
What tests are usually requested in these cases?
Generally, in addition to a complete physical examination to determine the pubertal stage, a complete blood test is usually requested, including sex hormone determinations and an X-ray of the hand to assess the patient’s ‘bone age’. These studies allow us to confirm the suspicion of precocious puberty, guide us as to its origin and allow us to assess whether it is necessary to carry out other more complex studies (specific analyses after hormonal stimulation, abdominal ultrasound, brain MRI…).
Does precocious puberty require treatment?
Not all patients require treatment; the decision must be individualised according to the patient. Hormone therapy with LHRH (Luteinising Hormone Releasing Hormone) analogues is usually used, which block the production of sex hormones. The objectives of the treatment are, on the one hand, the arrest or regression of the sexual characteristics that have appeared, and on the other hand, the slowing down of bone maturation for as long as the treatment is maintained. The treatment is intramuscular and is usually administered once a month, and is generally very well tolerated.
Ask us if you have any doubts, we do pediatric endocrinology consultations at home!
