The incidence of this disease in girls is higher than that in boys, but uninformed parents mistakenly think it is a "good thing"

"Doctor, my daughter is only 8 years old, how come she has already started developing breasts?"

"Doctor, my son is already 13 years old. He grew very fast in the past few years, but now he is half a head shorter than his classmates in the class."

This is a common doctor-patient dialogue in the Department of Endocrinology and Genetics Metabolism at Hebei Children's Hospital. Liu Lijun, director of the department, told reporters after a busy day of outpatient work, "These two polar-contrast dialogues are actually about the same disease, which is precocious puberty."

(Liu Lijun, director of the Department of Endocrinology and Genetics and Metabolism at Hebei Children's Hospital, is seeing patients)

The age of central precocious puberty is advanced, and the situation of the disease is not optimistic

It is understood that currently, children's precocious puberty is mainly divided into central precocious puberty (true precocious puberty), peripheral precocious puberty and partial precocious puberty. Central precocious puberty is further divided into idiopathic central precocious puberty and secondary central precocious puberty. Secondary central precocious puberty is caused by related tumors, such as germ cell tumors, hamartomas, and gliomas in the brain. Idiopathic central precocious puberty has no cause to be found, but is just an early activation of the hypothalamic pituitary-gonadal axis function. Director Liu Lijun introduced, "Currently, the public is concerned about and we diagnose more clinically, but central precocious puberty."

Normal puberty should start after the age of 10 for girls, and one or two years later for boys, at about the age of 11. The new version of the Expert Consensus on the Diagnosis and Treatment of Central Precocious Puberty adjusts the diagnostic age of central precocious puberty (CPP) from "secondary sexual characteristics before the age of 8 for girls and before the age of 9 for boys" to "breast development before the age of 7.5 for girls or menarche before the age of 10.0", and the age for boys remains unchanged. The change in the diagnostic criteria for central precocious puberty also highlights the severity of the current situation of precocious puberty in my country. According to the survey data released by the China Health Promotion and Education Association, the prevalence of precocious puberty in children in my country is 0.43%, and the incidence rate in girls is 5-10 times that of boys. Precocious puberty in children has become a high-incidence endocrine disease in children.

"We often advocate early diagnosis and treatment, but the proportion of children with precocious puberty who delay seeking medical treatment is seriously high. Because in the eyes of many parents, it is a good thing for children to grow tall and strong, but parents often ignore that behind the children's growth, the secondary sexual characteristics are also developing rapidly." Winter and summer vacations are the peak seasons for children's hospitals, and they are almost overcrowded every day. Many children will come to the city where their parents work to live together during the holidays, but what they see is that the children have become "little adults". Compared with the main manifestations of the development of secondary sexual characteristics in girls, which are breast bulges and lumps in the chest, the onset of precocious puberty in boys is more hidden.

Director Liu Lijun said that there are many cases of delayed diagnosis of precocious puberty in boys, because boys take baths by themselves after the age of 7 or 8, and parents cannot easily find it. In daily life, parents can identify it by the development of testicles. If his testicles have reached 4 ml before the age of 9, which is about the size of a Cangzhou jujube, then his secondary sexual characteristics have developed. Parents should bring their children to the hospital for treatment as soon as possible. "

Early development also means early end. Central precocious puberty seriously affects adult height.

"Now we see many tall students on campus. Why do children with precocious puberty delay seeking medical treatment? This has a lot to do with parents' expectations of height." Central precocious puberty is caused by the early activation of the hypothalamus-pituitary-gonadal axis (HPGA) function and the increase of gonadotropin-releasing hormone (GnRH), which leads to the development of gonads and the secretion of sex hormones, which causes the development of internal and external genitalia and the appearance of secondary sexual characteristics. Due to premature sexual development, children with precocious puberty experience accelerated growth in advance under the action of sex hormones, and are taller than children of the same age, but at the same time promote the early closure of the epiphysis and shorten the growth period. Once the epiphyseal line is closed, the space for growth is basically gone. Therefore, children with precocious puberty may be shorter than the average person in adulthood.

"The treatment goal of precocious puberty is to improve lifelong height in adulthood and make up for the shortened growth period." Director Liu Lijun introduced, "Currently, both clinically and in guidelines, the recommended treatment for central precocious puberty is gonadotropin-releasing hormone analogues (GnRHa). Through drug intervention, the premature development of children can be delayed, allowing children to resume normal development during puberty and strive to achieve genetic height." Faced with the common fear of hormones among parents, Director Liu Lijun also told reporters that the human body has a variety of hormones, such as growth hormone, sex hormones, thyroxine, insulin, parathyroid hormone, etc. They have different functions and different clinical indications. Parents should have a correct understanding and do not need to panic too much about hormones.

It is understood that the drugs currently used to treat central precocious puberty are one-month and three-month dosage forms. Survey data show that 50% of children with central precocious puberty fail to complete the full treatment. "The treatment cycle for children with central precocious puberty is generally about 2 years. Considering medication compliance and the cost of missed school and work, longer-acting dosage forms have outstanding advantages. However, during clinical treatment, children need to take medication according to the doctor's instructions." Director Liu Lijun said.

Diseases come from the mouth, healthy diet and regular work and rest are very important

At present, there are many factors that affect children's precocious puberty, including genes, environment, nutrition, eating habits, exercise, disease, social and psychological factors. Obesity is one of the most important factors affecting the onset and duration of puberty. Director Liu Lijun said, "Obesity caused by excessive nutritional intake greatly increases the probability of precocious puberty."

The "Report on the Nutrition and Chronic Disease Status of Chinese Residents" released by the National Health Commission in 2020 pointed out that the overweight and obesity rates of urban and rural residents of all ages in my country have continued to rise, among which the overweight and obesity rates of adult residents have exceeded 50%, children and adolescents aged 6 to 17 are close to 20%, and children under 6 have reached 10%. The report predicts that if it is not curbed, by 2030, the obesity rate among school-age children and adolescents will reach 31.8%, and that among preschool children will reach 15.6%.

Director Liu Lijun emphasized that children should pay attention to nutritional balance in their diet, try to eat natural ingredients, and avoid taking too many supplements, such as large amounts of honey, royal jelly, and bovine colostrum for a long time. In addition, in daily life, parents should urge their children to exercise properly, develop a regular schedule, go to bed as early as possible, and try not to sleep with the lights on.