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Precocious puberty

  • Symposium: Endocrinology—Part II
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Abstract

Puberty occurring before the age of 8 years in girls and 9 years in boys is considered precocious. The numerous causes of precocity can be classified as central or peripheral. Central or true precocious puberty (CPP) is due to premature activation of the hypothalamopituitary-gonadal axis and is isosexual. Peripheral or pseudoprecocious puberty (PPP) results from the production of sex steroids independent of the H-P-G axis and may be isosexual or heterosexual. CPP is the most common form of precocity involving more than 50% of children and is much more common in girls than boys. CPP is more common between 4 and 8 years. A peak serum LH levels >10 iu/1 following GnRH stimulation is the absolute evidence of CPP. Serum IGF-I levels are predictive of the outcome. Availability of CT and MRI has helped to determine the cause of CPP in most cases. Hypothalamic hamartoma is the most common tumour causing CPP especially in boys. Adrenal causes, particularly CAH, are the commonest cause of PPP in boys whereas ovarian causes are more likely in girls. Long acting GnRH analogues provide a safe and effective form of treatment of CPP.

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References

  1. Pescovitz OH, Comite F, Cassorla Fet al. True precocious puberty complicating congenital adrenal hyperplasia; treatment with, a luteinizing hormone-releasing hormone analogue.J. Clin. Endocrinol. Metab 1984: 58: 857–60.

    PubMed  CAS  Google Scholar 

  2. Pescovitz OH, Comite F, Hench K,et al, The NIH experience with precocious puberty: diagnostic subgroups and the response to short term luteinizing hormone releasing hormone analogue theraphy.J. Pediatric 1986; 108: 47–54.

    Article  CAS  Google Scholar 

  3. Sigurjonsdottir TJ, Hayles AB. Precocious puberty—a report of 96 cases.Am. J. Dis. Child. 1968; 115: 309–329.

    PubMed  CAS  Google Scholar 

  4. Rayner PHW.Early Puberty in Clinical Pediatric Endocrinology. Ed. Brook CGD. Oxford, Blackwell Scientific Publication, 1981; 224: 239.

    Google Scholar 

  5. Neeley EK, Lee PA Eckert KL,et al. Criteria for diagnosis of central precocious puberty.Pediatr. Res. 1993; 33: 81A.

    Google Scholar 

  6. Reiter EO, Kaplan SL, Conte FA, Grumback MM. Responsivity of pituitary gonadotropins to luteinizing hormone releasing factor in idiopathic precocious puberty, precocious, thelarche, precocious adrenache and in patients treated with medroxyprogesterone acetate.Pediatr. Res. 1975; 9: 111–116.

    PubMed  CAS  Google Scholar 

  7. Pescovitz OH, Hench KD, Barnes KM,et al. Premature thelarche and central precocious puberty: The relationship between clinical presentation and the gonadotropin response to luteinzing hormore releasing hormone.J. Clin. Endocrinol. Metab 1988; 67: 474–479.

    PubMed  CAS  Google Scholar 

  8. Crowley WF Jr., Comite F, Vale W,et al. Therapeutic use of pituitary desensitization with a long acting LHRH agonist: a potential new treatment for idiopathic precocious puberty.J. Clin. endocrinol Metab 1981; 52: 370–374.

    PubMed  Google Scholar 

  9. Boepple PA, Crowley WF Jr. Gonadotropin releasing hormone analogues as therapeutic probes in human growth and development: evidence from children with central precocious puberty.Acta Paediatr. Scand 1991; 372 (Suppl.): 33

    CAS  Google Scholar 

  10. Lin TH, Le Page ME, Henzl Met al. Intrasal nafarelin: an LHRH analogue treatment of gonadotropin—dependent precocious puberty.J. Pediatr. 1986: 109: 954–958.

    Article  PubMed  CAS  Google Scholar 

  11. Ross JL, Pescovitz OH, Barnes K.et al. GH secretary dynamics in children with precocious puberty.J. Pediatr. 1987; 110: 369–372.

    Article  PubMed  CAS  Google Scholar 

  12. Fontana M, Branner R, Prebot C,et al. Precocious puberty in girls: early diagnosis of a slowly progressing variant.Arch. Dis. Child 1989; 64: 1170–1176.

    Google Scholar 

  13. Attie MK, Ramirez NR, Conte FAet al. The pubertal growth spurt in 8 patients with true precocious puberty and growth hormone deficiency; Evidence for a direct role of sex steroids.J. Clin. Endocrinol. Metab. 1990; 71: 975–983.

    PubMed  CAS  Google Scholar 

  14. Sizonenko P. Precocious Puberty. In: Bertrand J, Rappaport R, Sizonenko PC. Williams and Wilkins Batimore, 1993.Pediatric Endocrinology: Physiology; Pathophysiology and Clinical Aspects, 2nd ed.

  15. Desai M, Colaco MP, Choksi CSet al. Isosexual precocity: The clinical and etiologic profile.Indian. J. Pediatr. 1993; 30: 607–623.

    CAS  Google Scholar 

  16. Vaidya RA. Diagnostic approach and management of precocious puberty.Indian J. Pediatr. 1982; 50: 254–257.

    Google Scholar 

  17. Prasanna Kumar KM, Ammini AC, Menon PSNet al. Sexual precocity: Clinical profile and laboratory evaluation.Indian J. Pediatr. 1987; 54:897–902.

    Article  Google Scholar 

  18. Khandekar S, Dash RJ. Clinical and hormonal studies in precocious puberty.Indian J. Pediatr. 1990; 57: 411–419.

    Article  PubMed  CAS  Google Scholar 

  19. Kappy MS, Ganoung CS. Advances in the treatment of precocious puberty.Advances in Pediatrics 1994; 41: 223–259.

    PubMed  CAS  Google Scholar 

  20. Judge DM, Kulin HE, Page R,et al. Hypothalamic hamartomas: a source of luterinizing hormone releasing factor in precocious puberty.N. Engl. J. Med. 1977; 296: 7–10.

    Article  PubMed  CAS  Google Scholar 

  21. Price RA, Lee PA, Albright AL,et al. Treatment of sexual precocity by removal of a luteinizing hormone secreting hamartoma.JAMA. 1984; 251:2247–2249.

    Article  PubMed  CAS  Google Scholar 

  22. Cacciari E, Frejaville E, Cicognani A,et al. How many cases of true precocious puberty in girls are idiopathic.J. Pediatr. 1983; 102: 357–360.

    Article  PubMed  CAS  Google Scholar 

  23. Grumbach M, Styne D. Puberty: Ontogeny, neuroendocrinology, physiology and disorders: In:Williams Textbook of Endocrinology ed. Wilson JD, Foster DW, WB Saunders Co., Philadelphia. 1139–1221.

  24. Colaco MP, Desai MP, Choksi CSet al. Hypothalamic harartomas and precocious puberty.Indian J. Pediatr. 1993; 60: 45–50.

    Article  Google Scholar 

  25. Hochman HI, Judge DH, Reichlin S. Precocious puberty and hypothalamic hamartoma.Pediatr. 1981; 67: 236–244.

    CAS  Google Scholar 

  26. Zuniger OF, Tanner SM, Wild WO, Mosier HD. Hamartoma of CNS associated with precocious puberty.Am. J. Dis. Child. 1983; 137: 127–133.

    Google Scholar 

  27. Van Wyk JJ, Grumback MM, Syndrome of precocious in juvenile hypothyroidism. An example of hormonal overlap in pituitary feed back.J. Pediatr. 1960; 57: 416–435.

    Article  Google Scholar 

  28. Hemandy ZS, Siler-Khodr TM, Najjar S. Precocious puberty in juvenile hypothyrodism.Pediatr. 1978; 92: 55–59.

    Article  Google Scholar 

  29. Burke G. Pubertal hypothyroidism: Case report and review of the literature.Metabolism 1961; 10: 126–133.

    PubMed  CAS  Google Scholar 

  30. Reiter EO, Brown RS, Longcope C, Beitin, IZ, Male limited familial precocious puberty in three generations: apparent leydig-cell autonomy and elevated glycoprotein hormone alpha subunit.New Engl. J. Med. 1977; 296: 7–10.

    Article  Google Scholar 

  31. Schedervie RK, Reiter EO, Beitins IZet al. Testicular leyding cell hyperplasia as a cause of familial sexual precocity.J. Clin. Endocrinol Metab. 1980; 52: 271–278.

    Google Scholar 

  32. Rosenthal SM, Grumbach MM, Kaplan SL, Gonadotropin independent familial sexual precocity with premature leydig and germinal cell maturation (“familial testotoxicosis”): effect of a potent luteinzing hormone releasing factor agonist and medroxyprogesterone acetate therapy in four cases.J. Clin. Endocrinol Metab. 1983; 57: 571–579.

    PubMed  CAS  Google Scholar 

  33. Manasco PK, Girton ME, Diggs RL,et al. A novel testis stimulating factor in familial male precocious pubety.N. Engl. J. Med. 1991: 324–227.

  34. Hall R, Warrick C. Hypersecretion of hypothalamic relasing hormones: a possible explanation of the endocrine manifestations of polyostotic fibrous dysplasia (Albright’s Syndrome).Lancet 1972; 1: 1313–1316.

    Article  PubMed  CAS  Google Scholar 

  35. Weinstein LS, Shenker A, Gejman PVet al. Activating mutations of the stimulatory G protein in the McCune—Albright syndromeN. Engl. J. Med. 1991; 325: 1688–1692.

    Article  PubMed  CAS  Google Scholar 

  36. Lyon A. De Bruyn R. Grant DB, Transient sexual precocity and ovarian cysts.Arch. Dis. Child. 1985; 60: 819–822.

    Article  PubMed  CAS  Google Scholar 

  37. Freedmand SM, Kreitzer PM, Elkowitz SS. Ovarian microcysts in girls with isolated premature thelarche.J. Pediatr. 1993; 122: 246.

    Article  Google Scholar 

  38. Van der Werff ten Bosch. Isosexual precocity. In: L.I. Gardarer (ed),Endocrine and Genetic Disease of Childhood and Adolescence, 2nd ed., 619–39.

  39. Zanegeh F, Kelley VC, Granulosa-theca cell tumour of the ovary in children.Am. J. Dis. Child., 1968: 115: 494–508.

    Google Scholar 

  40. Ilioki A, Lewin RP, Kauli R, Kaufman Het al. Premature thelarche, natural history and sex hormone secretion in 68 girls.Acta Paediatr. Scand, 1984; 73: 756–762.

    Article  Google Scholar 

  41. Pasquino AM, Piccola F, Scalamandre A,et al. Hypothalamic-pituitary-gonadotropic function in girls with premature thelarche.Arch. Dis. Child. 1980; 55: 941–945.

    PubMed  CAS  Google Scholar 

  42. Sizonenko PC, Preadolescent and adolescent endocrinology. Physiology and physiopathology 11. Hormonal changes during abnormal pubertal development.Am. J. Dis. Child. 1978; 132: 797.

    PubMed  CAS  Google Scholar 

  43. Dunnic M, Tajic M, Mardesic D, Kalafatic Z. Premature Thelarche: Possible Adrenal Disorder.

  44. Saenz de Rodriquez CA, Bongiovanni AM, Conde de Borrego L. An epidemic of precocious development in Puerto Rican children.J. Pediatr. 1987; 107: 393.

    Google Scholar 

  45. Sizonenko PC, Pannier L. Hormonal changes in puberty III. Correlation of plasma dehydroepiandosterone, testosterone, FSH and LH, with stages of puberty and bone age in normal boys and girls and in patients with Addison’s disease, or hypogonadism or with premature or late adrenarche.J. Clin Endocrinol Metab. 1975; 41: 894–904.

    PubMed  CAS  Google Scholar 

  46. Blano-Garcia M, Evain-Brion D, Roger M, Job JC. Isolated menses in prepubertal girls.Pediatrics, 1985; 76: 43–47.

    Google Scholar 

  47. Fontoura M, Brauner R, Prevot Cet al. Precocious puberty in girls: early diagnosis of a slowly progressing variant.Arch. Dis. Child. 1989; 64: 1170–1176.

    Article  PubMed  CAS  Google Scholar 

  48. Kulin HE, Santner SJ. Timed urinary gonadotropin measurements in normal infants, children and adults and in patients with disorders of sexual maturation.J. pediatr. 1977; 90: 760–765.

    Article  PubMed  CAS  Google Scholar 

  49. Escorbar ME, Rivarola MA, Bergada C. Plasma concentration of estradiol-17B in premature thelarche and in different types of sexual precocity.Acta Endocrinol 1976; 81: 351–361.

    Google Scholar 

  50. Chaussain JL, Savage MO, Nahoul Ket al. Hypothalmo-pituitary gonadal function in male central precocious puberty.Clin Endocrinol 1978; 8: 437–444.

    CAS  Google Scholar 

  51. Rommer B, Trumpy JH, Marhaug Get al. Hypothalamic hamartoma causing precocious puberty treated by surgery: case report surg.Neurol 1994; 41(4): 306–309.

    Google Scholar 

  52. Starceski PG, Lee PA, Albright AIet al. Hypothalamic Hamartomas and sexual precocity.Am J. Dis. Child. 1990; 144: 225–228.

    PubMed  CAS  Google Scholar 

  53. Boepple PA, Mansfield MG, Crawford JD, Final heights in girls with central precocious puberty following GnRH agonist—induced pituitary gonadal suppression.Pediatr. Res. 1991; 29: 74A (abstract).

    Google Scholar 

  54. Oerter KS, Manasco P, Barnes KM, et al. Adult height in precocious puberty after long term deslorelin.J. Clin. Endocrinol. Metab. 1991; 73: 1233–1239.

    Article  Google Scholar 

  55. Paul D, Grumbach MM, Kaplan SL. Effect of long term GnRH agonsits on final heights in children with true precocious puberty.Pediatr. Res. 1993; 33 (Suppl): S90 (Abstract).

    Article  Google Scholar 

  56. Holland FJ, Fishman L, Bailey JDet al. Ketoconazole in the management of precocious puberty not responsive to LHRH analogue therapy.N. Engl. J. Med. 1985; 312: 1023–1026.

    Article  PubMed  CAS  Google Scholar 

  57. Feuillan PP, Foster CM, Pescovitz OH. Treatment of precocious puberty in the Mc Cune Albright Syndrome with the aromatase inhibitor testolactone.N. Engl. J. Med. 1986; 315: 115–118.

    Article  Google Scholar 

  58. Lane L., Jones J, Barnes KMet al. Treatment of familial male precocious puberty with spironolactone, testolactone and deslorelin.J. Clin. Endocrinol Metab 1993; 76: 151–154.

    Article  Google Scholar 

  59. Werder EA, Murset G, Zachmann Met al. Treatment of precocious puberty with cyproterone acetate.Pediatr. Res. 1974; 8: 248–256.

    PubMed  CAS  Google Scholar 

  60. Ehrhardt AA, Meyer-Bahlburg HF. Psychosocial aspects of precocious puberty.Hormone Res. 1994; 41 Suppl. 2, 30–35.

    PubMed  Google Scholar 

  61. Mazur T, Clopper RR, Pubertal disorders. Psychology and clinical management. Endocrinol Metab.Clin. North Am. 1991: 20: 211–220.

    CAS  Google Scholar 

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Colaco, P. Precocious puberty. Indian J Pediatr 64, 165–175 (1997). https://doi.org/10.1007/BF02752439

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