In girls, precocious puberty involves early pubertal changes: breast development, pubic and axillary hair growth, and menarche before age 8. In true precocious puberty, the ovaries mature and pubertal changes progress in an orderly manner. In pseudoprecocious puberty, pubertal changes occur without ovarian maturation.

Causes of Precocious Puberty in Females

About 85% of all cases of true precocious puberty in females are constitutional, resulting from early development and activation of the endocrine glands without corresponding abnormalities. Other causes of true precocious puberty include central nervous system (CNS) disorders, such as hypothalamic tumors, intracranial tumors (pinealoma, granuloma, and hamartoma), hydrocephaly, degenerative encephalopathy, tuberous sclerosis, neurofibromatosis, encephalitis, skull injuries, and meningitis.

Pseudoprecocious puberty may result from increased levels of sex hormones due to ovarian and adrenocortical tumors, adrenocortical virilizing hyperplasia, ingestion of estrogens or androgens, and increased end-organ sensitivity to low levels of circulating sex hormones.

Signs & Symptoms of Precocious Puberty in Females

The breasts start to develop before age 8, or menstruation occurs before age 10, and growth is rapid in female.
In isosexual precocious puberty, feminizing Signs appear in girls, masculinization in boys.
Girls begin to menstruate more commonly with true precocious puberty, but menstruation may also occur with pseudoprecocious puberty. Body odor and acne, as well as behavior changes, may be present in both sexes.
Gonadotropin-dependent precocious puberty is marked by present high gonadotropin levels in girls.

Diagnostic tests

X-ray studies of hands, wrists, knees, and hips show bone age and premature epiphyseal closure.

Blood analyses of serum gonadotropin (follicle-stimulating hormone [FSH] and luteinizing hormone [LH]) and sex steroid (estradiol and progesterone) levels are in the normal adult range. Low levels of gonadotropins ndicate an ovarian or adrenal tumor; high levels suggest an intracranial lesion or a human chorionic go nadotropin-secreting tumor.

Laboratory tests, including vaginal smear and estrogen secretion, urinalysis for gonadotropic activity and excretion of 17-ketosteroids, and radioimmunoassay for both FSH and LH, define elevated values.

Ultrasonography, computed tomography (CT) scans, magnetic resonance imaging (MRI), laparoscopy, or exploratory laparotomy results may verify an abdominal lesion.

EEG, ventriculography, pneumoencephalography, CT scans, MRI, or angiography can be used to detect CNS disorders.

Treatment

Although still controversial. treatment of constitutional true precocious puberty may include medroxyprogesterone to reduce secretion of gonadotropins and prevent menstruation. Adrenogenital syndrome requires cortical or adrenocortical steroid replacement. Surgery may be needed to remove ovarian and adrenal tumors. Regression of secondary sex characteristics may follow such surgery, especially in young children. Choriocarcinomas may necessitate surgery, irradiation, or chemotherapy. Treatment for hypothyroidism requires thyroid extract or levothyroxine to decrease gonadotropic secretions.

Prevention Tips

Precocious puberty cannot be prevented.

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