The health of children at the stage of their growth and development is one of the most important problems for parents. Previously, if my child was taller than his peers, this was considered a positive sign, but now it is more likely to be interpreted as a negative sign that “precocious puberty” may have occurred. If treatment is delayed or neglected, the risk of premature closure of the growth plates increases.
Learn about precocious puberty with the help of Park Ki Yong, Pediatrics and Adolescent Specialist at Daejeon San Hospital.
Precocious puberty means that physical development occurs faster than peers. The first step in the evaluation of a child with suspected precocious puberty is the appearance of secondary sexual characteristics in girls under 8 years of age and boys under 9 years of age through a physical examination and examination.
In terms of symptoms of precocious puberty, secondary sexual characteristics include breast development with breast lumps and swelling in girls, testicular volume greater than 4 cm3 or longer than 2.5 cm in boys, and development of pubic hair in both men and women . Common symptoms include hair growth around the genital area in the armpit, in rare cases, sebum secretion is activated, acne appears, and sometimes an odor comes from the top of the head.
Precocious puberty is closely related to growth plates and height. In the case of precocious puberty, loss of final adult height, i.e. loss of growth potential, can occur due to premature fusion of the epiphyses, in which the growth plate closes prematurely as a result of precocious puberty. According to foreign documents, in the absence of treatment, the loss of the final height of an adult can reach 12 cm in girls and about 20 cm in boys.
As for the cause of precocious puberty, in 95% of cases, true precocious puberty in girls is idiopathic, the specific cause has not been established, but organic lesions with CNS disorders are often found. These organic causes are varied, but the most common lesions of the central nervous system are hypothalamic hamartomas, and there may be other types of intracranial tumors and other brain lesions such as encephalitis and encephalopathy. Therefore, if a brain lesion is suspected, magnetic resonance imaging (MRI) of the brain should be performed. Although other causes are rare, severe hypothyroidism and adrenal hyperplasia, if left untreated for a long time, can also cause precocious puberty.
With regard to the diagnosis and examination of precocious puberty, the first step is to check whether the secondary sexual characteristics, the development of the mammary glands in girls and the increase in testicular volume in boys begin less than 8 years for girls and less than 9 years for boys. through medical examination and examination.
The second is a bone age test and a sex hormone test. A bone age test measures bone maturity by x-raying the left hand and wrist bone, with bone age above chronological age. A test for sex hormones is possible, and gonadotropin in the blood in the morning. Phosphorluteinizing hormone, follicle-stimulating hormone, estradiol or testosterone are determined, while the diagnosis is possible with a test for gonadotropin stimulation of more than 5 IU / l maximum according to the domestic pediatric standard. to see if the results meet the diagnostic criteria.
If both the first symptom mentioned above and the second test result meet the criteria, precocious puberty is diagnosed.
Treatment aims to equalize pubertal development with peers, minimize loss of final adult height, and reduce psychosocial problems in girls who have menarche at a very early age, as well as rebellious and aggressive tendencies in boys. Early fusion of the growth plate of the bone can lead to short stature, so treatment is necessary.
As mentioned above, if untreated, the final height loss in adults can be up to 12 cm in girls and about 20 cm in boys. If the treatment is good, the final predicted height will definitely increase, and there are reports of 3-10 cm increase in girls, and it is estimated that another 4-6 cm can be gained with proper treatment.