What is considered normal and what is considered early development
Typically, the first signs of puberty in girls appear after 8 years with the growth of the mammary glands, and in boys after 9 years with the enlargement of the testicles. Anything that starts before these dates is considered premature and requires evaluation. Separately, isolated options are distinguished: only breast enlargement in a baby without other signs or only early hair growth. They often do not progress and require only observation. The main guidelines for the doctor are not a single sign, but the rate of increase in changes, growth rates and bone age.
- Girls: signs up to 8 years
- Boys: signs before 9 years
- Isolated thelarche - breast growth only
- Isolated adrenarche - only hair growth
- It's the rate of progression that matters, not just one symptom
Reasons
There is a central form, when the entire hypothalamus-pituitary-sex glands chain is turned on prematurely, and a peripheral form, when sex hormones are produced by the adrenal glands, ovaries, testes, or a tumor outside this chain. In girls, the central form most often has no obvious cause and is associated with hereditary characteristics and obesity. In boys, it much more often indicates damage to the central nervous system, so the examination is more thorough. Peripheral forms are caused by congenital dysfunction of the adrenal cortex, hormonally active tumors, ovarian cysts and accidental contact with hormonal drugs.
- Central form without established cause
- Tumors and malformations of the brain
- Consequences of injuries, infections, irradiation of the central nervous system
- Congenital dysfunction of the adrenal cortex
- Hormonally active tumors and cysts
- Contact with hormonal creams and drugs
- Obesity as a factor of earlier start
- Hereditary predisposition
How does it manifest itself?
In girls, the first thing that usually occurs is an enlargement of the mammary glands, sometimes with pain, then pubic and armpit hair appears, the smell of sweat changes, acne and mood changes are possible. Menstruation may begin later. In boys, the testicles and penis become enlarged, the voice becomes rougher, hair grows on the face and body, and acne appears. In both sexes, growth accelerates sharply, the child becomes the tallest in the class. An important psychological aspect is the discrepancy between appearance and age, which makes it difficult for a child to be among his peers.
- Enlarged mammary glands in a girl
- Enlargement of testicles and penis in a boy
- Pubic and armpit hair
- Adult type sweat odor, acne
- Sharp acceleration in growth
- Early menstruation
- Emotional instability
What examinations are needed
The doctor measures height and weight, assesses the stage of sexual development and constructs a growth curve based on previous measurements. The key study is an x-ray of the hand to determine bone age: with true early maturation, it is ahead of the passport age. Next, LH and FSH are determined, if necessary with a sample, as well as estradiol or testosterone; these data make it possible to distinguish the central form from the peripheral one. Girls undergo an ultrasound of the uterus and ovaries, boys - an ultrasound of the testicles. If the central form is confirmed, an MRI of the brain is prescribed.
- Assessment of growth and stage of development
- X-ray of the hand to determine bone age
- LH and FSH, stimulation test if necessary
- Estradiol or testosterone
- TSH and adrenal hormones according to indications
- Ultrasound of the uterus and ovaries or ultrasound of the testicles
- MRI of the brain with a central form
Treatment and observation
Tactics depend on the form and speed of progression. For slowly occurring isolated variants, observation with re-evaluation after a few months is sufficient. In the central form, which rapidly progresses and worsens the growth prognosis, drugs are used that temporarily stop the functioning of the pituitary gland; they are introduced according to a schedule and discontinued when the child reaches a suitable age, after which maturation resumes. In peripheral forms, the cause is treated: the tumor is removed; in case of congenital adrenal dysfunction, replacement therapy is selected. Psychological support for the child and family is also important.
- Observation for slow-onset forms
- Drugs that arrest maturation in the central form
- Removal of a hormonally active tumor
- Replacement therapy for adrenal dysfunction
- Avoiding contact with hormonal drugs
- Monitoring growth and bone age over time
- Psychological support for the child
- Working with excess weight