Precocious puberty
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| ICD-10 | E30.1, E22.8 |
|---|---|
| ICD-9 | 259.1 |
| OMIM | 176400 |
| DiseasesDB | 10519 |
| MedlinePlus | 001168 |
| eMedicine | ped/1882 |
| MeSH | D011629 |
Precocious puberty refers to an unusually early onset of puberty.
Contents |
[edit] 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.
[edit] Clinical significance
Early sexual development deserves evaluation because it may:
- induce early bone maturation and reduce eventual adult height,
- cause significant social problems, or
- 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. [1]
High levels of beta-hCG in serum and cerebospinal fliud observed in 9-year old boy suggest a pineal gland tumour. The tumour is called a chronic gonadotropin secreting pineal tumour. Radiography and chemotherapy reduced tumour and beta-hCG levels normalized.[2]
[edit] 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.
- Vaginal bleeding in girls before 10 years.
Suggested causes: Environmental estrogens, sedentary lifestyle, and obesity.
[edit] 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.
Children (esp. 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 tumour. Chemotherapy cures most intracranial tumours.[3]
The role of the pineal gland in reproduction of other species of vetebrate suggest that the pineal gland does have significance indevelopement and function of human reproductive axis.[4] In a study using neonatal melatonin on rats, results suggest that elevated melatonin could be responsible for some cases of early puberty.[5]
[edit] See also
[edit] References
- ^ Dickerman R, Stevens Q, Steide J, Schneider S (2004). "Precocious puberty associated with a pineal cyst: is it disinhibition of the hypothalamic-pituitary axis?". Neuro Endocrinol Lett 25 (3): 173-5. PMID 15349080.
- ^ Kuo H, Sheen J, Wu K, Wei H, Hsiao C. "Precocious puberty due to human chorionic gonadotropin-secreting pineal tumor". Chang Gung Med J 29 (2): 198-202. PMID 16767969.
- ^ Massie R, Shaw P, Burgess M (1993). "Intracranial choriocarcinoma causing precocious puberty and cured with combined modality therapy". J Paediatr Child Health 29 (6): 464-7. PMID 8286166.
- ^ Cavallo A (1993). "Melatonin and human puberty: current perspectives". J Pineal Res 15 (3): 115-21. PMID 8106956.
- ^ Esquifino A, Villanúa M, Agrasal C (1987). "Effect of neonatal melatonin administration on sexual development in the rat". J Steroid Biochem 27 (4-6): 1089-93. PMID 3121932. (4-6):1089-93
[edit] External links
thyroid Hypothyroidism (Iodine deficiency, Cretinism, Congenital hypothyroidism, Goitre) - Hyperthyroidism (Graves-Basedow disease, Toxic multinodular goitre) - Thyroiditis (De Quervain's thyroiditis, Hashimoto's thyroiditis)
pancreas Diabetes mellitus (type 1, type 2, coma, angiopathy, ketoacidosis, nephropathy, neuropathy, retinopathy) - Zollinger-Ellison syndrome
parathyroid Hypoparathyroidism (Pseudohypoparathyroidism) - Hyperparathyroidism (Primary hyperparathyroidism, Secondary hyperparathyroidism, Tertiary hyperparathyroidism)
pituitary hyperfunction (Acromegaly, Hyperprolactinaemia, Syndrome of inappropriate antidiuretic hormone) - Hypopituitarism (Sheehan's syndrome, Kallmann syndrome, Simmonds' disease, Growth hormone deficiency) - Diabetes insipidus - Hypothalamic-pituitary dysfunction
adrenal Cushing's syndrome (Nelson's syndrome, Pseudo-Cushing's syndrome) - Congenital adrenal hyperplasia (due to 21-hydroxylase deficiency) - Hyperaldosteronism (Conn syndrome, Bartter syndrome) - Adrenal insufficiency (Addison's disease) - Hypoaldosteronism
gonads Polycystic ovary syndrome - 5-alpha-reductase deficiency - Hypogonadism - Delayed puberty - Precocious puberty
other Autoimmune polyendocrine syndrome - Carcinoid syndrome - Laron syndrome - Psychogenic dwarfism - Androgen insensitivity syndrome - Progeria
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