Precocious Sexual Development
(Precocious Puberty; Premature Puberty)
Girls enter puberty between the ages of 8-14. Boys enter this stage between the ages of 9-14. Sometimes the physical changes may happen earlier. This is called precocious sexual development or premature puberty.
For girls, this means that before the age of eight they may:
- Develop breasts
- Have armpit or pubic hair
- Have mature sex organs
- Experience their first period
- Enlarged sex organs
- Armpit, pubic, or facial hair
Most of the time (ie, 90%) there is no known cause. With boys, between 25%–75% of these cases are due to an underlying reason.
Some known causes of premature sexual development:
- Hormone-secreting tumor (gonadotropin-secreting tumor)
- Severe hypothyroidism]]>
- ]]>Congenital adrenal hyperplasia]]>
- McCune-Albright syndrome (females)
- Adrenal tumor
Tumor or lesion
- Central nervous system
- Pituitary gland
Causes specific to girls:
- Having ovarian tumor or ]]>cysts]]>
- Taking estrogen
- Having tumors on the testicles
- Taking male sex hormones (androgens)
Factors that increase the risk of precocious puberty include:
- Sex: girls are 2 to 5 times more likely to experience premature puberty than boys
- Family history—some cases may run in families
- Taking sex hormones
- Head injury
- Radiation of head
- Infection in brain
- Some studies have suggested a link between obesity]]> and premature puberty
One symptom common to both boys and girls is a premature growth spurt in height. Children with this condition may be taller than their peers. As an adult, they may be shorter. The rapid growth also makes their bones stop growing sooner than normal. Other symptoms include:
- Breast development
- Pubic hair
- Armpit hair
- Onset of period
- Ovary enlargement
- Cysts on ovaries
- Facial hair
- Armpit hair
- Pubic hair
- Penis growth
- Increased masculinity
- Testicle enlargement
In both girls and boys:
- Body odor
- Behavior changes
- Growth spurt
The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. An assessment of puberty milestones and growth will be done. An x-ray]]> of the left wrist bone may be taken. This will help to assess if bone growth is normal for your child’s age.
Depending on these results, other tests may be ordered, including:
- Adrenal and ]]>pelvic ultrasound]]>
- ]]>MRI]]> of the brain
- In girls: follicle-stimulating hormone (FSH), luteinizing hormone (LH)
- In boys: testosterone
- Human chorionic gonadotropin (hCG) levels
- Thyroid hormone levels if hypothyroidism suspected
- Growth hormone-releasing hormone (GHRH) stimulation test
- Dehydroepiandrosterone (DHEA) levels
- Testicular ultrasound if testicular enlargement is uneven
The treatment depends upon the cause. If the bone age is about the same as their actual age, and there is no known cause, there is no treatment. The child will continue to be monitored.
Hormone suppressors work by halting or slowing sexual development. These medications may include:
]]>Metformin]]> has also been shown to be effective in delaying puberty.
Support may be valuable for children who are more physically mature than their peers.
Hormone-producing tumors or other lesions may cause premature puberty. They are usually removed with a surgery.
The doctor will continue to monitor your child’s height, weight, and sexual development. This will chart the progress. It will also show if any given treatment has been effective.
The American Academy of Family Physicians
American Academy of Pediatrics
The Magic Foundation
About Kids Health
Caring for Kids
Blondell RD, Foster MB, Kamlesh CD. Disorders of puberty. American Family Physician website. Available at: http://www.aafp.org/afp/990700ap/209.html . Accessed July 5, 2005.
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DeVries L, Kaschansky A, Shohert M, et al. Familial central precocious puberty suggests autosomal dominant inheritance. J Clin Endocrinol Metab . 2004;89:1794-1800.
Himes JH, Obarzanek E, Baranowski T, et al. Early sexual maturation, body composition, and obesity in African-American girls. Obesity Research . 2004;12:64S-72S.
Ibanez L, Valls C, Ong K, et al. Metformin therapy during puberty delays menarche, prolongs pubertal growth, and augments adult height: a randomized study in low birth weight girls with early-normal onset of puberty. J Clin Endocrinol Metab . 2006;91:2068-2073.
The Merck Manual . Available at: http://www.merck.com/mrkshared/CVMHighLight?file=/mrkshared/mmanual/section19/chapter275/275b.jsp%3Fregion%3Dmerckcom&word=precocious&word=puberty&domain=www.merck.com#hl_anchor . Accessed July 17, 2005.
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Precocious puberty. Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/print/ency/article/001168.htm . Accessed July 17, 2005.
Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics . 2002;110:903-910.
Last reviewed January 2009 by ]]>Rosalyn Carson-DeWitt, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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