Precocious puberty

Definitions & Key takeaways

Precocious puberty, also known as early puberty, refers to the occurrence of secondary sexual characteristics in children before the age of 8 in girls and before the age of 9 in boys. In some children, early development is triggered by a disease such as a tumor or injury of the brain. Precocious puberty can also be a result of other pathologies such as pinealoma, McCune-Albright syndrome, and 21-hydroxylase deficiency. Treatment for precocious puberty usually involves hormone therapy or medications to suppress the early activation of the hypothalamic-pituitary-gonadal axis.

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Introduction0:00–0:25

Puberty is the time in an individual's life when they physically become sexually mature and able to have Children. Precocious refers to puberty occurring at an earlier age than the average age among an individual's peers.
Generally, puberty is considered precocious that begins before the age of eight in females and the age of nine in males.
The hypothalamic pituitary gonadal axis is a system of hormone signaling between the hypothalamus, pituitary gland and gonads.

Physiology of sex hormones0:25–1:16

Either the testes or ovaries to control sexual development and reproduction. Gonadotropin releasing hormone is released by the hypothalamus into the hypophyseal portal system, which is a network of capillaries connecting the hypothalamus to the hypothesis or the pituitary.
When gonadotropin releasing hormone reaches the pituitary gland, it stimulates cells in the anterior pituitary called gonadotrophs to release gonadotropin hormones, luteinizing hormone and follicle stimulating hormone into the blood.
These gonadotropin hormones then stimulate the gonads to produce specific steroids, sex hormones. Beginning at puberty, the Leydig cells of the testes respond to the volutin hormone by converting more cholesterol into testosterone.

Sexual development1:16–2:51

In addition, the sertoli cells of the testes respond to follicle stimulating hormone by producing more sperm. The major sexspecific hormones in women are estrogen and progesterone and they are produced by the ovarian follicles that are scattered on the ovaries.
Each ovarian follicle is made up of a ring of granulosa cells surrounding a primary o site at its core. Beginning at puberty.
Theca cells respond to luteinizing hormone by producing androstenedione, an androgen. Then the granulosa cells respond to follicle stimulating hormone by converting the androstenedione into estrogen and progesterone waves of estrogen and progesterone regulate monthly changes to the ovary stroma to promote egg maturation and ovulation and changes to the uterine wall lining.
As part of the menstrual cycle. The increased production of sex hormones drives the development of primary and secondary sex characteristics observed during puberty.
Primary sex characteristics refers to the genitals organs directly involved in sexual reproduction. Secondary sex characteristics refers to any sexspecific physical characteristic that is not directly involved or necessary in sexual reproduction like pubic hair and breasts.
In females, the tanner scale or tanner stages is a predictable set of steps that males and females go through as they develop primary and secondary sex characteristics and become sexually mature.

Tanner scale2:51–4:06

The tanner scale centers on two independent criteria, the appearance of pubic hair in both sexes and the increase in testicular volume and penile size and length in males and breast development.
In females. There are five stages in stage one, the p pubertal stage, no pubic hair is present in either sex.
Males have a small penis and testes. Females have a flat chest.
In stage two, pubic hair appears, there is a measurable enlargement of the testes and breast buds appear in stage three, pubic hair becomes coarser.
The penis begins to enlarge in both size and length and breast mounds form. In stage four, pubic hair begins to cover the pubic area.
The penis begins to widen and breast enlargement continues to form a mound on mound contour of the breast. In stage five, pubic hair extends to the inner thigh.
The penis and testes have enlarged to adult size and the breast takes on an adult contour. Precocious puberty is when a child starts progressing through the tanner scale before 95% of other Children.

Pathophysiology4:06–6:03

That age generally, that means that puberty has started before the age of eight in females and nine in males. Precocious puberty is usually due to a central or peripheral problem, central precocious puberty or gonadotropin dependent precocious puberty results from early maturation of the hypothalamic pituitary gonadal axis.
When that happens, it causes an early release of luteinizing hormone and follicle stimulating hormone, which in turn causes an increase in sex hormones.
Ultimately, early maturation of the hypothalamic pituitary gonadal axis could be due to a dysfunctional hypothalamus or pituitary gland.
One cause could be a tumor that's releasing gonadotropin releasing hormones or human chorionic gonadotropin. A placental hormone that's similar to luteinizing hormone.
Another cause is an infection or cysts or radiation damage to the brain that impairs the negative feedback system in the hypothalamic pituitary gonadal axis.
But most of the time there's no identifiable pathology. And it's simply called idiopathic precocious puberty.
Idiopathic precocious puberty is considered a normal variation in the age at which puberty begins and is influenced by factors like when a parent began puberty as well as an individual's weight.
The other category, peripheral coccois puberty or gonadotropin, independent precocious puberty is the result of the abnormal overproduction of sex hormones.
But the testes or ovaries, this could be caused by an ovarian or testicular cyst or tumor. Genetic conditions like mcu Albright syndrome, dysfunction of other glands like the thyroid or adrenal gland or exogenous sex hormones from medications and creams.

Symptoms6:03–6:15

The key feature of precocious puberty is early sexual maturation and it often causes a lot of emotional distress because Children can feel social pressures that come along with sexual maturity.
Pre puberty is diagnosed using the tanner scale gonadotropin hormone levels can help distinguish gonadotropin dependent or independent causes.

Diagnosis6:15–6:32

And medical imaging by ultrasound or MRI can be used to look for structural abnormalities in the brain and gonads. Treatment for pathologic causes of central precocious puberty typically involves using gonadotropin releasing hormone analogs which can suppress the hypothalamic pituitary gonadal axis hormones.

Treatment6:32–7:10

They work by binding to the gonadotropin releasing hormone receptor on the pituitary gland and decreasing the release of luteinizing hormone and follicle stimulating hormone that ultimately reduces the levels of sex hormones and slows puberty.
Treatment for peripheral precocious puberty depends on the cause. In some cases, surgery is needed to remove a tumor or cyst from the ovaries or testicles.

Review7:10–7:42

All right. As a quick recap, precocious puberty means that puberty has started early, typically before the age of eight in females and before the age of nine in males, it's usually identified using tanner staging.
Oftentimes there's no underlying pathology and it's considered a normal variation called idiopathic precocious puberty. If there is an underlying pathology, it's typically due to central or peripheral causes that ultimately result in early release of the sex hormones, which leads to early sexual development.