Has my child developed early? Will he not grow taller in the future?

This is the 3811th article of Da Yi Xiao Hu

- Happy Children's Day -

Parents often come to the clinic with anxious children and ask, "Doctor, is my child considered to be premature? Will he not grow tall in the future? What causes it? Is there any good way to stop or slow down the child's premature development?" Sometimes, parents who are late to the party bring their children who have already had their period to consult. Especially since the epidemic, children have been taking online classes at home for several times, eating a lot and lacking exercise. These problems have become common scenes in the pediatric endocrinology clinic. Now let's talk about these things about precocious puberty.

Overview

When children reach puberty and begin the process of sexual development and maturation too early, it is called precocious puberty or early puberty. Girls with this phenomenon will show early sexual characteristics before the age of 8 and boys will show early sexual characteristics before the age of 9.

Most children with precocious puberty initially grow faster than their peers, but often complete their growth before reaching their expected height. At the same time, these children may experience psychological and social difficulties because they are not mentally and emotionally prepared for puberty while experiencing physical changes.

Thankfully, though, with proper treatment and daily care, most children with precocious puberty will eventually go through a normal and happy puberty. The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of puberty.

What are the symptoms of precocious puberty?

Although each child may experience different symptoms of early puberty, they generally mirror those of normal puberty, just at different times:

Girls: Height/growth spurts, breast development, menstrual cramps or vaginal bleeding

Boys: Enlarged testicles and penis, pubic and armpit hair, facial hair, acne, deepening of the voice

What causes precocious puberty?

In girls, about 90% to 95% of precocious puberty is idiopathic, or unknown, meaning the cause is unknown and doctors don't know why it happens. Boys are more likely to have an underlying, identifiable cause.

To understand what causes early sexual development in children, we must first understand the mechanism that triggers puberty. The brain begins the process by producing a hormone called gonadotropin-releasing hormone (GnRH). When this hormone acts on the pituitary gland, it causes an increase in the secretion of estrogen by the ovaries in women and testosterone by the testicles in men. It is well known that estrogen is involved in the growth and development of female sexual characteristics, while testosterone plays a role in the sexual maturation process in men.

Precocious puberty is divided into central and

Peripheral precocious puberty

Central precocious puberty (GnRH-dependent) is the most common type, which occurs more often in girls than boys and is triggered by premature secretion of gonadotropins in the brain. In contrast, peripheral precocious puberty (GnRH-independent) is not triggered by the early release of gonadotropins in the brain, but rather by androgens or estrogens produced elsewhere in the body.

1. Common causes of central precocious puberty

As mentioned earlier, the root cause of this type of precocious puberty is often unknown. In central precocious puberty, puberty begins too early, but other than the timing, the sequence and progression of sexual development is normal. This is also called idiopathic central precocious puberty. For children with this type, there is no underlying disorder or identifiable cause of early puberty.

In rare cases, central precocious puberty is secondary to a central nervous system or other disorder:

√ Congenital brain defects, such as hydrocephalus or noncancerous tumors (hamartomas)

√ Radiation to the brain or spinal cord

√ Brain or spinal cord injury

√ Pituitary or brain tumor

√ Family history

Certain rare genetic syndromes, such as McCune-Albright syndrome and congenital adrenal hyperplasia.

2. Common causes of peripheral precocious puberty

Abnormal production of estrogen or testosterone in the body can cause this type of precocious puberty. This relatively rare type of precocious puberty occurs without any connection to the normal release of GnRH in the brain that triggers puberty. Instead, the early onset of sexual development is caused by problems with the ovaries, testicles, adrenal glands, or pituitary gland, which cause estrogen or testosterone to be released into the body.

In both girls and boys, the following factors may contribute to peripheral precocious puberty:

√ Adrenal or pituitary tumors that secrete estrogen or testosterone

Exposure to exogenous estrogen or testosterone, such as cosmetics, creams, or ointments

In girls, peripheral precocious puberty may also be associated with:

√ Ovarian cyst

√ Ovarian tumor

In boys, peripheral precocious puberty may also be caused by:

√ Tumors in the cells that produce sperm (germ cells) or testosterone (Leydig cells).

A rare disorder called familial male-independent precocious puberty, caused by a gene defect, leads to early production of testosterone in boys (usually between 1 and 4 years old).

Does precocious puberty have any impact on children?

√ Restricted height: Children with precocious puberty may grow very fast and very tall at first compared to children of the same age. However, because their bones mature faster than normal and the growth period is shortened, they stop growing earlier than children of normal age. This can cause their adult height to be shorter than the normal average. Therefore, if children with precocious puberty, especially those who are younger, are treated early, it can help them grow taller than without treatment.

√ Psychosocial adjustment problems: Girls and boys who enter puberty earlier than their peers may be particularly sensitive to changes in their bodies, which may affect confidence and self-esteem and increase the risk of psychological disorders such as depression.

√ Risk of breast tumors: Studies have found that children with precocious puberty have a higher risk of developing breast tumors in adulthood than children with normal development, which may be related to premature exposure to estrogen stimulation.

How do doctors diagnose whether a child has precocious puberty?

1. First, the doctor will review the child's medical history, growth and development history, and family history with the parents and perform a physical examination on the child.

2. Then, the doctor will order some blood tests to determine your child's hormone levels.

3. Next, the doctor will ask the child to take an X-ray of the left wrist bones to help understand the bone age.

4. Again, the doctor will need to do a GnRH stimulation test to distinguish the type of precocious puberty. After drawing blood first, the doctor will inject the child with a certain dose of GnRH. Then multiple blood samples are taken over a period of time to check the hormone response in the child's body. In children with central precocious puberty, the GnRH hormone causes the levels of other hormones to increase. In children with peripheral precocious puberty, the levels of other hormones remain unchanged.

If it is central precocious puberty, the following tests are also required:

1. Magnetic resonance imaging (MRI). MRI of the brain is often done in children with central precocious puberty to see if the child has any brain abnormalities that are causing early development.

2. Thyroid function test. If your child has any signs of hypothyroidism, such as fatigue, weakness, intolerance to cold, constipation, poor school performance, or pale, dry skin, your doctor will draw blood to test thyroid function.

Children with peripheral precocious puberty may also need other tests to find out the cause of their condition. For example, doctors may do blood tests to check other hormone levels, and girls may need an ultrasound to check for ovarian cysts or tumors.

How to treat precocious puberty?

The main goal of treatment for precocious puberty is to allow the child to reach normal adult height.

The treatment of precocious puberty depends on the cause. Whether some children with central precocious puberty whose cause cannot be found need treatment depends on the age at which the child begins sexual development and the speed of puberty progression. Therefore, in this case, the doctor may follow up the child for a few months to understand the progress of his development.

As mentioned earlier, most children with central precocious puberty do not have an underlying medical condition, but if the rate of sexual development is so rapid that it affects the child's adult height, it can be effectively treated with medication. This treatment, called GnRH analog therapy, usually involves injecting a medication, such as leuprolide acetate (Lupron Depot) or triptorelin (Trelstar, Triptodur Kit), to slow the progression of development.

If doctors find that there is another underlying disorder causing your child's early puberty, they first treat the underlying disorder to stop the onset of puberty. For example, if your child has a tumor that secretes hormones and causes early puberty, surgical removal of the tumor will usually stop the early onset of puberty.

Early Publication

When a child enters puberty (the process of becoming sexual mature) too early, it's called precocious puberty, or early puberty. Children experiencing the condition develop early sexual characteristics; in girls this means before age 8, and in boys, this means before age 9.

Most children with the disorder grow faster than their peers at first, but finish growing before reaching their anticipated height. Children with this disorder may have psychosocial difficulties as they may not be emotionally prepared for the physical changes of puberty and may feel self-conscious about these changes.

Fortunately, however, with proper treatment and care, most children with precocious puberty will ultimately experience a normal and happy adolescence. The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of puberty.

What are the signs of precocious puberty?

Although each child may experience signs of precocious puberty differently, they are generally the same as the signs of regular puberty, the timing is different though, including:

Girls: increasing height/growth spurt, breast development, menstruation or vaginal bleeding

Boys: enlarging testicles and penis, pubic and underarm hair, facial hair, development of acne, deepening of the voice.

What causes precocious puberty?

In girls, the cause of precocious puberty 90 to 95 percent of the time is idiopathic, or unknown, meaning doctors don't know for certain why it happens. Boys are more likely to have an underlying identifiable cause.

To understand what causes precocious puberty in some children, it's helpful to know what causes puberty to begin. The brain starts the process with the production of a hormone called gonadotropin-releasing hormone (GnRH). When this hormone reaches the pituitary gland, it leads to the production of more hormones in the ovaries for females (estrogen) and the testicles for males (testosterone). Estrogen is involved in the growth and development of female sexual characteristics. Testosterone is responsible for the growth and development of male sexual characteristics.

There are two types of precocious puberty:

Central precocious puberty (gonadotropin-dependent) is the most common, affecting more girls than boys. It's triggered by the premature secretion of gonadotropins from the brain. Peripheral precocious puberty (gonadotropin-independent) is not triggered by the early release of gonadotropin hormones in the brain, but by androgen and estrogen production from other parts of the body.

1. What causes central precocious puberty?

The cause for this type of precocious puberty often can't be identified. In central precocious puberty, the puberty process starts too soon. The pattern and timing of the steps in the process are otherwise normal. For the majority of children with this condition, there's no underlying medical problem and no identifiable reason for the early puberty.

In rare cases, central precocious puberty may be caused by:

Ÿ a defect in the brain present at birth, such as hydrocephalus or hamartoma

Ÿ radiation to the brain or spinal cord

Ÿ Injury to the brain or spinal cord

Ÿ tumors of the pituitary gland or brain

Ÿ family history of the disorder

Ÿ Certain rare genetic syndromes, such as McCune-Albright syndrome, Congenital adrenal hyperplasia.

2. What causes peripheral precocious puberty?

Estrogen or testosterone in your child's body causes this type of precocious puberty. The less common peripheral precocious puberty occurs without the involvement of GnRH that normally triggers the start of puberty. Instead, the cause is release of estrogen or testosterone into the body because of problems with the ovaries, testicles, adrenal glands or pituitary gland.

In both girls and boys, the following may lead to peripheral precocious puberty:

Ÿ A tumor in the adrenal glands or in the pituitary gland that releases estrogen or testosterone

Ÿ Exposure to external sources of estrogen or testosterone, such as creams or ointments

In girls, peripheral precocious puberty may also be associated with:

Ÿ Ovarian cysts

Ÿ Ovarian tumors

In boys, peripheral precocious puberty may also be caused by:

Ÿ A tumor in the cells that make sperm (germ cells) or in the cells that make testosterone (Leydig cells).

Ÿ A rare disorder called gonadotropin-independent familial sexual precocity, which is caused by a defect in a gene, can result in the early production of testosterone in boys, usually between ages 1 and 4.

How will precocious puberty affect my child?

Ÿ Short height. Children with precocious puberty may grow quickly at first and be tall, compared with their peers. But, because their bones mature more quickly than normal, they often stop growing earlier than usual. This can cause them to be shorter than average as adults. Early treatment of precocious puberty, especially when it occurs in very young children, can help them grow taller than they would without treatment.

Ÿ Social and emotional problems. Girls and boys who begin puberty long before their peers may be extremely self-conscious about the changes occurring in their bodies. This may affect self-esteem and increase the risk of depression or other psychological problems.

Ÿ Risk of breast cancer: girls who start puberty early may be at higher risk for breast cancer when they're older. It's because of exposure to estrogen at an earlier age.

How is precocious puberty diagnosed?

1. Firstly, the doctor will review your child's and your family's medical history and do a physical exam.

2. Next, the doctor will run blood tests to measure hormone levels

3. Then, the doctor will order an X-rays of child's hand and wrist to help determine child's bone age, which shows if the bones are growing too quickly.

4. To determining the type of precocious puberty, doctor will perform a test called a gonadotropin-releasing hormone (GnRH) stimulation test. In this test, the doctor will take a blood sample, and then give your child a shot containing the GnRH hormone. More blood samples are then taken over a certain period of time to check how hormones in your child's body react. In children with central precocious puberty, the GnRH hormone will cause other hormone levels to rise. In children with Peripheral precocious puberty, other hormone levels stay the same.

Additional testing for central precocious puberty:

1. Magnetic resonance imaging (MRI). A brain MRI is usually done for children who have central precocious puberty to see if any brain abnormalities are causing the early start of puberty.

2.Thyroid testing. The doctor may also test your child's thyroid if he or she shows any signs of slow thyroid function (hypothyroidism), such as fatigue, sluggishness, increased sensitivity to cold, constipation, a drop in school performance or pale, dry skin.

Other tests also are necessary for children with peripheral precocious puberty to find the cause of their condition. For example, the doctor may run additional blood tests to check other hormone levels or, in girls, he or she may do an ultrasound to check for an ovarian cyst or tumor.

Author: Doctor of Pediatrics, School of Medicine, University of Melbourne, Australia

Pediatrician at ParkwayHealth (China)

Jiang Benran