Recently, I read an article in a newspaper about EARLY PUBERTY in children. In the article, the writer described the case of a young girl who was just 1+ year old, still in diapers and still could not speak properly, when she started her first period. It happened so suddenly and then it stopped. But after a year or so, the spotting returned and soon after, her parent noticed other unexpected changes, hair developing in her underarms and other areas, and chest growth. The parents got alarmed and consulted several paediatric endocrinologists, who did battery of tests to rule out tumour or cancer. In the end it was diagnosed that she is suffering from “Precocious Puberty”, a condition where the body begins puberty much earlier than normal.
What is Precocious Puberty
It occurs when puberty begins before the age of eight in girls or nine in boys. While some cases stem from serious conditions like tumours, most are treatable. In the above mentioned case tests revealed that girl is having elevated levels of hormone, and ultrasound showed that her uterus had already started to develop at such a young age. She was administrated the medications for suppressing the hormone.
Early puberty leads to lot of psychological problems and physical discomfort for the girl as the mind and body is not mature enough to deal with the changes, not to forget the massive mood swings, Pre Mensural Symptoms (PMS) and other teen emotions. Early puberty can lead to development of sexual urges at an early age. This can be dangerous as the girls not mentally mature enough to understand and constructively channelize these urges. Early maturing girls attract unwanted attention from the opposite sex. No matter how physically developed a girl is, her psychological maturation remains anchored to her chronological age and hence she is not able to come terms with what is happening. She becomes socially awkward and starts shunning social interaction, sometimes leading to depression.
Symptoms
Precocious puberty symptoms include
- Breast growth and first period in girls.
- Testicle and penis growth, facial hair and deeper voice in boys.
- Public or underarm hair.
- Rapid growth.
- Acne
- Adult body odour.
When to see a doctor
Make an appointment with your child’s healthcare provider if your child has symptoms of early of precocious puberty.
Causes
To understand the causes of precocious puberty in some children, it is helpful to know what happens at puberty. The brain starts the process by making a hormone called gonadotropin-releasing hormone (GnRH). When this hormone reaches thee small, bean-shaped gland at the base of the brain, called pituitary gland, it lead to more estrogen in the ovaries and more testosterone in testicles. Estrogen makes female sex traits, and testosterone makes male sex traits.
There are two types of precocious puberty:
Central Precocious Puberty– In this case, puberty starts too soon but develops as usual. For most children with this condition, there is no medical problem or other known reason for early puberty. In rare cases, the following can cause this condition:
- A tumour in brain or spinal chord.
- A change in the brain that is present at birth. This could be fluid built up, known as hydrocephalus, or a tumour that is not a cancer, known as hamartona.
- Radiation to the brain or spinal chord or injury to either of them.
- A rare genetic disease that affects bones and skin colour and causes hormonal problems, known as McCune-Albright syndrome.
- A group of genetic issues, called congenital adrenal hyperplasia, that involve the adrenal gland making atypical hormones.
- A condition called hypothyroidism in which the thyroid gland does not make enough hormones.
Peripheral Precocious Puberty– Estrogen or testosterone being made too soon causes this condition. In this case hormone GnRH that typically causes puberty to start is not involved. Instead, the cause is the release of estrogen testosterone into the body. A problem with the ovaries, testicles, adrenal glands or pituitary glands causes hormone release. Following can cause this condition:
- A tumour in adrenal gland or in pituitary gland that releases estrogen or testosterone.
- A rare genetic disease that affects bones and skin colour and causes hormonal problems, as stated above.
- Being exposed to creams or ointments that contain estrogen or testosterone.
In girls this condition can also be linked to
- Ovarian cysts.
- Ovarian tumours.
In boys, this can be also due to
- A tumour in the cells that make sperm or in the cells that make testosterone.
- A rare genetic condition called gonadotropin-independent familial sexual precocity. This can cause boys, usually between ages 1-4 to make testosterone too early.
Risk Factors– Factors that increase the risk of precocious puberty include:
- Being a girl- Girls are more likely than boys to have precocious puberty.
- Being obese-Carrying extra weight increase the risk of precocious puberty.
Complications– Possible complications of precocious puberty include:
- Short height– Children with this condition might grow quickly at first and be taller than other their ages. But their bones mature too soon. So these children often stop growing earlier than usual. This can cause them to be shorter than average as adults.
- Social and emotional problems-Children who begin puberty long before others of their age might be upset about the changes in their bodies. For example, dealing with early periods can cause distress. This might affect self-esteem and raise the risk of depression or using illegal drugs or alcohol.
Prevention- No one can avoid some of the risk factors for precocious puberty, such as sex and race. But there are things that can lower children’s chances of precocious puberty including:
- Keep anything that contains estrogen or testosterone away from children. These might include prescription medicines for adults or diet supplements.
- Encourage children to stay at a healthy weight.
Treatment of precocious puberty depends on the cause. Please consult your child’s doctor if your child has the problem of precocious puberty.
Waiting for your feedback on this blog.
Anil Malik
Mumbai, India
11th November 2024.