Parents, do you understand the disease of precocious puberty?

This is the 5145th article of Da Yi Xiao Hu

This morning, a mother and daughter came to the outpatient clinic. The little girl had a childish face and a cheerful personality, but the mother had a worried look on her face. She asked me anxiously, "Doctor, my child is only 7 years old and she got her period yesterday. Is it too early?" While I was comforting the mother, I examined the child. The girl was 7 years old, 136cm tall, and weighed 40kg. The physical examination showed that her breasts were stage B4 and she had a lot of pubic hair. Then I prescribed tests, pelvic ultrasound, and bone age films for the child. The results came out in the afternoon: bone age was 13 years old. Combined with the size of the uterus and sex hormones, it was diagnosed as central precocious puberty, and the predicted adult height was only 141cm. The mother couldn't believe it, "I'm 160cm tall and his father is 172cm tall. How can the child be so short?"

What is central precocious puberty?

90% of precocious puberty occurs in females, and the incidence in girls is 5-10 times that of boys. The normal process of puberty development for girls: first, breast development (mostly manifested as a lump under the areola, sometimes tender, followed by gradual enlargement of the breasts), accompanied by a sudden increase in height, followed by the gradual growth of pubic hair, reproductive organs, armpit hair, and finally menarche. One year after menarche, 90% of girls' height growth basically stops. Usually girls develop breasts at the age of 10 and have their first menarche at around the age of 13. Mothers often have a misunderstanding that menarche is the beginning of puberty. In fact, menarche is a sign that puberty is about to end, and it also means that height growth is about to end.

If a girl develops secondary sexual characteristics before the age of 8 or starts menstruating before the age of 10, she is considered to be precocious. According to epidemiological surveys, the precocious puberty rate among Chinese children is about 0.5%, which means that one in every 200 children is precocious. In some economically developed cities, the prevalence rate is even higher, up to 3%, and the prevalence rate in cities is higher than in rural areas! So mothers must pay attention to this.

The dangers of central precocious puberty

There are three types of precocious puberty: true precocious puberty, false precocious puberty, and incomplete precocious puberty. Central precocious puberty is also called true precocious puberty: it is the same as the normal puberty development process, except that puberty comes several years earlier. Causes: 20% of them are due to organic lesions, such as hypothalamic, pituitary tumors or other central nervous system lesions; about 80% of children cannot find the cause, which is called idiopathic precocious puberty, which often affects the child's lifelong height after adulthood.

Children with central precocious puberty will experience a sudden growth spurt prematurely because they enter puberty too early. They will stand out in the class at first, but they will soon have their first period too early. One year after menarche, 90% of girls' height growth basically stops. During the first year of menarche, most girls grow less than 5cm in height. Some children grow more, up to about 7-9cm, but some children can only grow about 2-3cm. This means that children will grow a few years shorter than their peers, making their adult height often not reach the ideal state. Short stature will bring children inferiority, anxiety and depression, and frustration in finding a job, affected marriage, limited potential and many other disadvantages will follow in adulthood.

How to treat central precocious puberty

The primary disease needs to be treated so that the developed secondary sexual characteristics can gradually subside, sex hormones can be restored to pre-pubertal levels, and the final adult height can be improved. At the same time, the psychological and behavioral problems caused by premature maturity in children should be avoided.

Specific treatment plan : Find the cause. For those caused by diseases, the primary disease needs to be treated, such as surgical removal of tumors; for idiopathic precocious puberty, the focus should be on the child's height, and the bone age needs to be assessed. The bone age is not the physiological age, but the bone age that is closely related to the child's height. When the girl's bone age reaches about 13-14 years old, the height growth basically stops, so it is necessary to estimate the child's lifelong height in adulthood based on the bone age. The bone age of children with central precocious puberty is often more than 2 years ahead of their actual age, which means that they will be a few years shorter than children of the same age. If the child's lifelong height is assessed to be low, drugs such as GnRHa need to be used to inhibit the gonad axis, return the child to the pre-pubertal state, delay the progression of bone age, prolong the growth time, and improve the final adult height, but this drug cannot accelerate the growth rate. If the adult lifelong height is assessed to be too low or the growth rate is not ideal after the application of GnRHa, growth hormone can also be used at the same time to accelerate the growth rate. Mothers often worry about whether the use of GnRHa will affect girls' future fertility. Many studies have shown that the long-term reproductive outcomes of children with precocious puberty treated with GnRHa, such as menstrual cycle, pregnancy rate, and live birth rate, are not significantly different from those of normal people, so mothers can use it with more confidence.

I asked the mother about the child's development, and she recalled that the child had complained of breast pain more than two years ago, but she did not quite understand at the time that this was a sign of puberty and did not seek medical treatment in time. It was not until the onset of menstruation that she realized the seriousness of the problem, but it was too late.

In the process of children's growth, some mothers are very careful and will know and seek medical treatment in time if their children have slight abnormalities, so that the disease will stop abruptly; while some mothers are careless and ignore many details of their children's developmental abnormalities, so that they delay and regret it too late. Mothers should know more about the basic knowledge of children's development. Once problems are found, they should seek medical treatment in time. Only in this way can children grow up healthily like small trees under the careful care of their parents!

Author: Department of Reproductive Endocrinology, Taiyuan Maternal and Child Health Hospital

Li Yan