Precocious Puberty – Diagnosis and Treatment
Diagnosis
Telling What Kind of Early Puberty It Is
Doctors first look at the child’s symptoms, family history, and perform a physical exam. They order blood tests to measure levels of sex hormones like estrogen or testosterone.
An important test is the GnRH stimulation test. For this test, doctors take a blood sample, give a shot of a hormone called GnRH, and then take more blood.
If sex hormone levels go up after the shot, the cause usually relates to the brain (central origin). If they stay the same, the cause may be somewhere outside the brain (peripheral origin).
A table that shows the difference is helpful:
| Type | Result after GnRH Test |
|---|---|
| Central early puberty | Hormones increase |
| Peripheral early puberty | Hormones stay the same |
Extra Exams for Brain-Related Early Puberty
If the cause appears to be central (brain-related), more tests help find out why. An MRI of the brain can reveal problems like tumors or structural issues in the hypothalamus or pituitary gland.
Doctors may also order thyroid tests to check if the thyroid is making enough hormone. When the thyroid is low, it can sometimes lead to early puberty.
These tests are used if the child shows symptoms like fatigue, sensitivity to cold, pale skin, or declining school performance.
Extra Exams for Non-Brain Causes of Early Puberty
If the early puberty does not come from the brain, doctors run more blood tests to measure hormone levels and find other sources of the problem. In girls, doctors might perform an ultrasound to look for ovarian cysts or tumors.
Boys might need other special tests. The goal is to check the ovaries, testicles, or adrenal glands for issues that cause excess hormone production.
Treatment
Managing Early Puberty Caused by the Brain
Central precocious puberty, which starts because of early hormone signals from the brain, is usually treated with medicines called GnRH analogues. These medicines delay changes until the right age.
Doctors use monthly hormone-suppressing injections to help manage the condition. Some types offer longer-lasting effects, so a child might need fewer shots.
A table showing common medicines used:
| Medicine Name | How It’s Given | How Often |
|---|---|---|
| Gonadotropin-releasing hormone (GnRH) agonist injection | Injection | Every 1-3 months |
| Long-acting GnRH agonist injection | Injection | Every 1-3 months |
| Subcutaneous GnRH agonist implant | Small implant in arm | Once a year |
The GnRH agonist implant is another way to give treatment. A small device goes under the skin, releasing the medicine slowly. It can last up to a year and requires a short surgery to put it in and take it out. After stopping the treatment, puberty usually starts again naturally.
Helping Children With Health Issues That Cause Early Puberty
If a health problem like a tumor or thyroid issue causes early puberty, the best plan is to treat that problem. For example, removing a tumor in the adrenal glands or brain can lower high levels of androgens, estrogens, or other hormones.
Some children may need hormone replacement therapy or medication to treat certain conditions, like hypothyroidism, to stop the body from going through puberty too soon. When the problem is fixed, puberty may slow down or stop progressing.
Managing Feelings and Getting Help
Children who start puberty early can sometimes feel different from their classmates. This difference might affect their self-esteem and lead to emotional challenges.
These changes can sometimes cause issues like anxiety or friendships becoming strained.
Ways families can support their child:
- Listen to your child’s concerns and reassure them.
- Speak with a health care team member for advice.
- Consider seeing a counselor for extra support.
- Praise achievements outside of appearance, like good grades or sports.
Support at home and school helps children feel understood and more confident.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Preparation before the appointment is important. Ask the office if your child should avoid food or drink for several hours beforehand, especially if lab tests may be done.
Bring your child’s growth charts or medical records, especially if the provider is new to your family.
Before visiting the provider:
- Talk with your child about what might happen during the exam, including possible checks of genitals and breast tissue.
- Write down symptoms. Note when signs of puberty began, such as acne, body odor, voice changes, or physical development.
- List all medicines and supplements. Include vitamins and over-the-counter items your child is taking, as well as any medications taken regularly by household members.
- Gather family height information. List adult heights for close relatives. Mark if anyone is notably shorter than average.
- Track family health history. Note if anyone in the family has had early puberty, hormone conditions, or seen an endocrinologist.
- Prepare questions. Use a table or list like the one below to organize:
| Question Topic | Example Question |
|---|---|
| Cause of symptoms | What might be causing these signs of puberty? |
| Tests and diagnosis | What types of tests will be needed? |
| Treatment and timeline | What are the treatment options and how long might it last? |
| Home care and restrictions | Are there activities or foods my child should avoid? |
Bringing this information helps the healthcare provider and can make the visit less stressful for you and your child.
What the Healthcare Provider May Want to Know
During the visit, your provider will likely:
- Ask when symptoms first appeared and if you have noticed changes, such as acne or body odor.
- Review your child’s medical history, family health background, and possible major life changes.
- Inquire if family members experienced early or late puberty, or have a history of endocrine problems.
- Ask about the family’s racial background, as this can sometimes be relevant to normal timing of sexual maturity.
- Perform a physical exam, which may include looking for changes such as breast development, pubic hair, and genital changes.
- Ask about any medications or supplements.
The provider may suggest that some children see a pediatric endocrinologist for further evaluation.
