Premature puberty in children

Premature sexual development (PPR) is the early onset of the formation of secondary sexual characteristics in children: up to 8 years in girls and up to 9 years in boys.

Symptoms of premature sexual development

The onset of sexual development is characterized by physical and emotional changes that, as a rule, do not go unnoticed by parents. Early sexual development in girls under 8 years of age is manifested by an increase in mammary glands, the appearance of pubic hair and armpits, and the appearance of acne.Boys under the age of 9 have enlarged testicles and penis, a "broken" voice, puberty, and acne. An increase in the level of sex hormones in the blood leads to an increased rate of bone development, in girls fat is redistributed according to the female type (hips are rounded, a waist appears), in boys muscle mass increases. It happens that the first symptom that attracts attention is an acceleration of growth: a child who used to be the same height as his peers or lower suddenly begins to grow rapidly, outstripping other children.

Causes and forms of premature puberty

There are two types of PPR. Central PPR is the premature "activation" of the central mechanisms regulating puberty (sexual development). Its other name is gonadotropin–dependent PPR (caused by the action of gonadotropic hormones of the pituitary gland). The central mechanisms of regulation of sexual development are located in the hypothalamus and pituitary gland, where hormones are produced that act on hormone-producing cells of the ovaries and testicles, stimulating the production of sex hormones in them - estrogens in girls and androgens in boys (see figure) .

The scheme of regulation of sexual development. The hypothalamus produces gonadotropin-releasing hormone (Gh-RH), which triggers the synthesis of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in the pituitary gland. LH and FSH, in turn, act on the sex glands, stimulating the synthesis of androgens in the testicles and estrogens in the ovaries.

"Premature start" can be the result of organic damage to the nervous system, the consequence of injury, the presence of a bulky formation in the brain. Sometimes it happens that the examination does not reveal serious organic causes, and in this case, the so-called idiopathic (“causeless") central PPD is established.

The second type of PPR is peripheral. Peripheral PPR is characterized by the fact that the ovaries or testicles (testicles) begin to produce an increased amount of sex hormones themselves. The cause may be hormone-producing cysts, bulky formations.

It is also worth noting that there is a division of PPR into full and incomplete forms. When fully formed, sex hormones act on all organs and tissues dependent on them, so in such cases, not only the appearance of secondary sexual characteristics is noted, but also the enlargement and development of the uterus and ovaries in girls, the penis and testicles in boys, and the growth processes are accelerated.

The incomplete form of premature sexual development is distinguished by either the isolated appearance of mammary glands in girls (telarche), or the isolated appearance of pubic hair (adrenarche, pubarche) in the absence of other signs of sexual development.

Complications and consequences

PPR can be associated with great psycho-emotional stress for a child: at an age when it is natural to strive to be like friends in everything, the child begins to differ sharply from other children, which can become a source of complexes and difficulties in communication.

Another significant complication in PPR is the deterioration of the growth prognosis. The outperformance in the growth of peers is due to accelerated bone maturation. A child has a "growth spurt" early, growth zones close earlier, and therefore the final growth of children with ASD may be below average.

Diagnostic methods

The appearance of signs of sexual development in girls under 8 years of age and boys under 9 years of age is a reason to consult a pediatric endocrinologist.

In order to determine whether or not there is PPR and to understand the causes of the changes that have appeared, the doctor conducts an examination with an assessment of the degree of sexual development, measurement of height and growth rate. The child's life history is being investigated in order to identify possible causes of PPR. Next, a study is conducted, including an assessment of the hormonal profile, determination of bone age, ultrasound examination of the sex glands, and MRI (if necessary). Often, a special laboratory test may be required to assess the functional activity of the central link regulating gonadal function. This is due to the fact that pituitary gonadotropins are secreted into the blood in a pulse mode and taking blood on an empty stomach may not always reflect their true level. Therefore, for the differential diagnosis between the central and peripheral forms of PPR, according to the indications, a test is performed with a drug that allows to assess the maximum level of gonadotropin hormones in the blood.

Treatment of premature puberty in girls and boys

Gonadotropin-releasing hormone (Gh-RH) analogues are used to treat the central form of premature sexual development. With regular administration, this drug blocks the secretion of pituitary sex hormones (LH and FSH). The most common mode of administration of the drug is intramuscular injection once every 28 days. Treatment with Gh-RG analogues is usually well tolerated. During the first month of treatment, there may be increased signs of sexual development, decreasing with proper administration. Side effects are rare and include headache, menopausal symptoms, and possible inflammation at the injection site.

Peripheral forms of PPR require a different approach to treatment. In these cases, therapy with Gh-RG analogues is ineffective, since there is no increased pubertal secretion of pituitary gonadotropins in these variants of PPD. The choice of treatment tactics depends on the cause of PPR.In some cases, surgical intervention (removal of a cyst or tumor) may be required, or the possibility of using drugs that block the effect of sex steroids on target organs may be considered.

Central precocious sexual development: to treat or not to treat?

The issue of the need for central PPD therapy is decided individually. Treatment has several goals: on the one hand, to stop the effect of sex hormones on bone tissue and improve the growth prognosis, on the other hand, to remove the negative impact on the psycho-emotional background of the child. Therefore, when deciding on cPPR therapy, the doctor evaluates several factors: the age and height of the child at the time of diagnosis, the rate of progression of signs of sexual development, the degree of psychological readiness of the child for sexual development.

Sexual development: a conversation with a child

Not only the attending physician, but also the parents should discuss with the child what is happening to his body. It is very important to make it clear to the child that he is normal and the changes that his body is undergoing are natural, albeit somewhat premature. Under the age of 8, sexual development can frighten children, but if they feel confident and supported by their parents, it will be much easier for them to accept the situation.