Precocious puberty is the development of sexual characteristics before age 8 in girls and before age 9 in boys. Signs may include pubic hair, acne, breast development, or testicular enlargement.
Precocious puberty may be caused by genetic factors, nervous system disorders, or a tumor. The specific cause is not always the same for every child.
Identifying the cause of precocious puberty is important so that a pediatric endocrinologist can recommend the appropriate treatment. Early treatment may help prevent possible complications.
Signs and symptoms
The most common signs and symptoms of precocious puberty include:
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Growth of pubic and underarm hair
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Increased skin oiliness, which may lead to acne
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Breast development in girls
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The first menstrual period, known as menarche, in girls
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Enlargement of the testicles and penis in boys
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Deepening of the voice in boys
These changes appear before age 8 in girls and before age 9 in boys.
If any of these changes are noticed, the child should be evaluated by a pediatric endocrinologist. The doctor can perform a general assessment and recommend treatment if necessary.
Confirming a diagnosis
Precocious puberty is diagnosed by a pediatric endocrinologist based on the child’s signs, symptoms, medical history, and a physical examination.
The doctor may also order a bone age X-ray of the hand and wrist. According to the Eunice Kennedy Shriver National Institute of Child Health and Human Development, imaging tests such as a pelvic ultrasound or brain MRI may also be used to rule out a tumor or another underlying abnormality.
Blood tests may also be ordered to measure luteinizing hormone (LH), follicle-stimulating hormone (FSH), androstenedione, estradiol in girls, and testosterone in boys.
Possible causes
The main causes of precocious puberty include:
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A disorder affecting the nervous system
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An ovarian tumor that causes the early production of female hormones and triggers puberty
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Hormonal changes caused by a head injury
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A tumor in the testicles
Identifying the cause of precocious puberty allows the doctor to recommend the most appropriate treatment when necessary.
Treatment options
Treatment for precocious puberty should be supervised by a pediatric endocrinologist and depends on the cause and the child’s age.
The main treatments for precocious puberty include:
1. Medical monitoring
Regular follow-up with a pediatric endocrinologist may be recommended to monitor the child’s growth rate and pubertal development.
The doctor may also order periodic blood tests or bone age X-rays and prescribe medication if necessary, depending on the child’s age, diagnosis, and how quickly puberty is progressing.
2. Medication
Medications may be prescribed to pause pubertal development and help the child reach their expected adult height.
The main FDA-approved medications for central precocious puberty include:
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Leuprolide acetate
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Triptorelin pamoate
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Histrelin acetate implant
According to the FDA, these medications are gonadotropin-releasing hormone agonists used to treat this condition in children.
The medication prescribed depends on the child’s age and sex, as well as the underlying cause. In some cases, glucocorticoids may also be prescribed to treat an adrenal gland disorder.
3. Surgery
Surgery may be recommended when precocious puberty is caused by a tumor in the adrenal glands or gonads, such as the ovaries or testicles. Removing the tumor may help prevent certain complications.
In some cases, radiation therapy or chemotherapy may also be necessary.
4. Mental health support
Therapy can be an important part of treatment for children with precocious puberty. A child may feel confused or anxious because others may expect them to act older than they are.
A psychologist or other mental health professional can also guide parents or caregivers on how to encourage age-appropriate behavior and support the child’s interests, such as playing with friends.