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| | __NOTOC__ |
| | {{Precocious puberty}} |
| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{DiseaseDisorder infobox |
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| Name = Precocious puberty |
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| ICD10 = {{ICD10|E|30|1|e|20}}, {{ICD10|E|22|8|e|20}} |
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| ICD9 = {{ICD9|259.1}} |
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| OMIM = 176400|
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| DiseasesDB = 10519|
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| MedlinePlus = 001168|
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| MeshID = D011629 |
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| {{SI}}
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| {{Editor Join}} | | {{CMG}} Associate Editor (s)-In-Chief: [[User:Dina|Dina Elantably, MD]][mailto:dina.antably@gmail.com] |
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| ==Overview==
| | {{SK}} |
| '''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 [[human variability|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.
| | pubertas praecox, sexual precocity |
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| ==Types and causes== | | ==[[Precocious puberty overview|Overview]]== |
| Early [[pubic hair]], [[breast]], or [[genital]] development may result from natural early maturation or from several other conditions.
| | [[Precocious puberty]] is defined as the development of secondary [[sexual]] characters before the age of eight in [[females]] and nine in [[males]]. The causes of [[precocious puberty]] are numerous and it can range from being a variant of normal development to severe [[life-threatening]] cause (eg; [[germ cell tumor]]). Physicians should differentiate central and peripheral causes of [[precocious puberty]] and determine the need for [[treatment]]. |
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| * 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).
| | ==[[Precocious puberty historical perspective|Historical Perspective]]== |
| | ==[[Precocious puberty classification|Classification]]== |
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| | ==[[Precocious puberty pathophysiology|Pathophysiology]]== |
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| * Secondary sexual development induced by [[sex steroid]]s from other abnormal sources ([[gonad]]al or [[adrenal]] [[tumor]]s, [[congenital adrenal hyperplasia]], etc.) is referred to as ''peripheral precocious puberty'' or ''precocious pseudopuberty''.
| | ==[[Precocious puberty causes|Causes]]== |
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| ==Clinical significance==
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| Early sexual development deserves evaluation because it may:
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| # induce early [[bone maturation]] and reduce eventual adult height,
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| # cause significant social problems (such as the child becoming an object of sexual attraction, even pedophilia) or
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| # indicate the presence of a tumor or other serious problem.
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| Central precocious puberty can be caused by intracranial neoplasm, infection, trauma, hydrocephalus, and [[Angelman syndrome]]. <ref>{{cite journal |author=Dickerman R, Stevens Q, Steide J, Schneider S |title=Precocious puberty associated with a pineal cyst: is it disinhibition of the hypothalamic-pituitary axis? |journal=Neuro Endocrinol Lett |volume=25 |issue=3 |pages=173-5 |year=2004 |pmid=15349080}}</ref>
| | ==[[Differentiating Precocious puberty from other diseases|Differentiating Precocious puberty from other Diseases]]== |
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| 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.<ref>{{cite journal |author=Kuo H, Sheen J, Wu K, Wei H, Hsiao C |title=Precocious puberty due to human chorionic gonadotropin-secreting pineal tumor |journal=Chang Gung Med J |volume=29 |issue=2 |pages=198-202 |year= |pmid=16767969}}</ref>
| | ==[[Precocious puberty epidemiology and demographics|Epidemiology and Demographics]]== |
| "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)
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| 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.
| | ==[[Precocious puberty risk factors|Risk Factors]]== |
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| ==Measures==
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| 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.
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| 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:
| | ==[[Precocious puberty screening|Screening]]== |
| * [[Pubic hair]] or genital enlargement in boys with onset before 9 years.
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| * Breast development in boys before appearance of pubic hair and [[testicle|testicular]] enlargement.
| | ==[[Precocious puberty natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * Pubic hair before 8 or breast development in girls with onset before 7 years.
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| * Menstruation in girls before 10 years.
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| '''Suggested causes:''' Environmental estrogens, sedentary lifestyle. | | ==[[Diagnosis]]== |
| | '''History and Symptoms:''' |
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| == Differential Diagnosis ==
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| *After [[Meningitis]]
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| *[[Brain Tumor]]s
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| *Endogenous sexual steroids
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| *Exogenic sexual steroids
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| *[[Inflammation]]
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| *Internal hydrocephalus
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| *[[McCune-Allbright Syndrome]]
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| *[[Pellizzi's Syndrome]]
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| *[[Radiation]]
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| *Recurrent [[seizure]]s
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| *[[Tumor]]s
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| ==Other notes== | | ==[[Treatment]]== |
| 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.
| | '''Central precocious puberty''' |
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| 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. <ref>{{cite journal |author=Massie R, Shaw P, Burgess M |title=Intracranial choriocarcinoma causing precocious puberty and cured with combined modality therapy |journal=J Paediatr Child Health |volume=29 |issue=6 |pages=464-7 |year=1993 |pmid=8286166}}</ref>
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| 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.<ref>{{cite journal |author=Cavallo A |title=Melatonin and human puberty: current perspectives |journal=J Pineal Res |volume=15 |issue=3 |pages=115-21 |year=1993 |pmid=8106956}}</ref> In a study using neonatal melatonin on rats, results suggest that elevated melatonin could be responsible for some cases of early puberty.<ref>{{cite journal |author=Esquifino A, Villanúa M, Agrasal C |title=Effect of neonatal melatonin administration on sexual development in the rat |journal=J Steroid Biochem |volume=27 |issue=4-6 |pages=1089-93 |year=1987 |pmid=3121932}}(4-6):1089-93</ref>
| | [[Precocious puberty medical therapy|Medical Therapy]] | [[Precocious puberty surgery|Surgery]] | [[Precocious puberty primary prevention|Primary Prevention]] | [[Precocious puberty secondary prevention|Secondary Prevention]] | [[Precocious puberty cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Precocious puberty future or investigational therapies|Future or Investigational Therapies]] |
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| == See also == | | ==Case Studies== |
| * [[Delayed puberty]]
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| ==References==
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| {{Reflist|2}}
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| (European Journal of Pediatrics;March2005,Vol.164 Issue 3, p173-174,2p,1 graph)
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| ==External links== | | ==Related Chapters== |
| * [http://www.med.umich.edu/1libr/yourchild/puberty.htm University of Michigan]
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| *[http://www.center4research.org/children11.html When Little Girls Become Women: Early Onset of Puberty Among Girls]
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| {{Endocrine pathology}} | | {{WikiDoc Help Menu}} |
| {{SIB}} | | {{WikiDoc Sources}} |
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| [[Category:Developmental biology]]
| | ==References== |
| [[Category:Pediatrics]] | | [[Category:Pediatrics]] |
| [[Category:Sexuality and age]]
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| [[Category:Endocrinology]] | | [[Category:Endocrinology]] |
| [[Category:Mature chapter]]
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| [[Category:Disease state]]
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| [[de:Pubertas praecox]]
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| [[es:Pubertad precoz]]
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| [[nl:Pubertas praecox]]
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| [[pl:Przedwczesne pokwitanie]]
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| [[pt:Puberdade precoce]]
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