Gonadotropin

TYPES OF PRECOCIOUS PUBERTY (EARLY PUBERTY)

Precocious Puberty has numerous types, all are listed below :

1. Central Precocious Puberty
2. Peripheral Precocious Puberty
3. Gonadotropin independent Precocious Puberty
4. Male limited Precocious Puberty
5. Gonadotropin Dependent Puberty
6. Idiopathic Precocious Puberty
7. Isosexual precocious puberty

Let’s elaborate some of them.

CENTRAL PRECOCIOUS PUBERTY

The brain starts storing gonadotropin growth hormone, quickly, unusually and at a premature stage. Gonadotropin is nestled in the pituitary gland and it enables and allows gonads to pass signals to ovaries (in girls) and testes( in boys) to form the sex hormones and because of gonadotropin physical changes can be seen in children with the age of 8-10 years and in teenagers also.

PERIPHERAL PRECOCIOUS PUBERTY

Peripheral precocious puberty is completely different from the central precocious puberty because this one is seen in fewer children hence, it is uncommon and doesn’t involve any kind of gonadotropin interference. But this surely happens because of 2 hormones, androgen and estrogen as both these hormones start functioning quickly causing some sort of disturbances in the ovaries and testes and leads to formation of ovarian cyst in girls and testicular tumour in boys. In a few cases, McCune – Albright syndrome is also noted which makes faults and defects in skin colour and destroys the bone in some way or the other. Peripheral precocious puberty is also known as gonadotropin independent precocious puberty because gonadotropin hormone is absent in this.

OTHER CATEGORIES OF PRECOCIOUS PUBERTY

Here, we are going to discuss 2 extremely rare precocious puberty types but still, it can be dangerous.

Male-limited Precocious Puberty 

As the name itself shows that this is entirely male-oriented puberty and this doesn’t harm girls. In this extremely premature age i.e. boys with 5-6 years of age get affected devastatingly and signs become visible at the age of 4-6. Also, in the initial stage, their hormones are at peak but eventually growth hormones permanently stop working properly and as a result, their height and facial hair stop growing. It could be hereditary and it could be not. 

Premature adrenarche – When adrenal gland begins to store androgen at a lesser age such kind precocious puberty occurs  1-2% cases are hardly reported of this.

EARLY PUBERTY TREATMENT

If the frequency of symptoms and signs is mild then don’t push your child into the treatment procedure of precocious puberty as symptoms normalize and slowly vanish on its own.

But if symptoms are intense and the child’s age is not near to adolescence or teenage then its a high time, urgency of treatment is ringing the bell. 

CENTRAL PRECOCIOUS PUBERTY TREATMENT

Mainly treatment focuses on slowing down the pituitary gland’s gonadotropin hormone formation. LHRH and GnRH agonists put a break on gonads strategy and ultimately matured sexual hormones take a u-turn and never pass by. GnRH comes in the form of an injection which should be given once or twice in a month, according to doctor’s advice and severity level.

This treatment helps to increase the height and stops them from premature. Most doctors advise continuing treatment for 1-2 years to get maximum benefits.

PERIPHERAL PRECOCIOUS PUBERTY  TREATMENT 

On which stage, androgen and estrogen are harming the body should be thoroughly discussed with the doctor and after examining the overall situation doctors prescribe the medicines and necessary treatment for peripheral precocious puberty. 

To make the best choice, you and your child’s doctor should work to decide all of the above options are reliable and efficient.

PRECOCIOUS PUBERTY MEDICATIONS

Medication is often an undeniable part of treatment for a child with acute precocious puberty. The best medication is Lupron-Depot therapy. Not only this one is effective but is mild and doesn’t cause much side effects. 

If used properly Leuprolide acetate reduces ovarian cyst formation and testicular tumor formation. Should be used if your child is 10 or below who has early puberty. After 10-11 it is not recommended. The cost for gonadotropin’s suppressants is somewhere around 15,000-20,000 dollars per year.

Other medicines are :

• Histrelin – Helps in reducing LH and FSH levels.
• Triptorelin – Can be used by kids with the age of 3 or above.
• Nafarelin – This promotes suppression of gonadal activities and is found in the form of nasal spray.

PRECOCIOUS  PUBERTY DIAGNOSIS

Advanced Bone Age Treatment :

Several tests have been discovered to check internal bone health, such as :

• X-ray
• Blood test
• Bone density test
• Dual-energy x-ray absorptiometry 

For pituitary examination, MRI Scanning might help and ultrasound tests are also used by some doctors. 

Symptoms

Here are signs and symptoms of Precocious Puberty :

COMMON SYMPTOMS IN GIRLS AND BOYS 

• Aggressive nature
• Mood swings
• Sudden height growth
• Body odour becomes like mature adults
• Face Acne/pimples
• Hair growth in armpits and in the pubic area.

SYMPTOMS IN GIRLS

• Breast development
• Menstruation cycle starts

SYMPTOMS IN BOYS

• Husky, harsh and deep voice
• Facial starts appearing
• Increase in the size of the penis and testicles grow
• Spontaneous erection and ejaculation
• Muscles gets larger

Causes

EARLY PUBERTY CAUSES

Numerous theories are applied and tests are done, but the real cause of precocious puberty is still hiding behind the curtains. Especially in girls early puberty, more than 95% of cases, the reason is still unknown. 

In boys,

• Familial recurrence
• Disturbance in hormones
• Damaged central nervous system
• Brain tumors
• Pituitary inflammation
• Involvement of rare genes

All these causes of precocious puberty or early puberty in boys state that you are physically maturing very early than the other boys of your age.

FAQ

1. WHAT ARE THE RISK FACTORS INVOLVED WITH PRECOCIOUS PUBERTY?

Genes coming from the father's side and mother’s side are equally risky and possibilities are there that genes can be responsible for early onset puberty. It can put a child into other conditions such as leukaemia, obesity, etc.

2. WHAT IS THE PROGNOSIS WITH THE TREATMENT?

Precocious puberty in girls with 8 yrs and boys yrs, with appropriate treatment, can give a good height just like other girls and boys. In upcoming years, one should try to manage gonadotropin hormone by feeding GnRH agonist through injection and by taking oral medicines one can expect a normal life.

3. WHICH CONDITIONS ARE SIMILAR TO EARLY PUBERTY?

Premature thelarche and premature pubarche have similar causes and symptoms. In premature thelarche girls breast development begins at the age of 3 or 4 years and in premature pubarche, pubic hair starts growing at the age of 6-8 years in both boys and girls.

4. WHAT SHOULD BE THE LEVEL OF TESTOSTERONE IN THE BOYS WITH THE AGE OF 8-9?

Ideal testosterone level in the boys at the age 8-9 is 27-30 ng/dL. If it exceeds 30 ng/dL then mild symptoms of early puberty start popping up and more than 100 ng/dL is an extreme level of precocious puberty.