Precocious puberty 651370 224952994 2008-07-11T04:16:36Z 72.192.94.145 [[WP:UNDO|Undid]] revision 224286927 by [[Special:Contributions/72.192.94.145|72.192.94.145]] ([[User talk:72.192.94.145|talk]]) {{DiseaseDisorder infobox | Name = Precocious puberty | ICD10 = {{ICD10|E|30|1|e|20}}, {{ICD10|E|22|8|e|20}} | ICD9 = {{ICD9|259.1}} | OMIM = 176400| DiseasesDB = 10519| MedlinePlus = 001168| eMedicineSubj = ped| eMedicineTopic = 1882| MeshID = D011629 | }} '''Precocious puberty''' (La:''pubertas praecox'') is an unusually early onset of [[puberty]], the process of sexual maturation triggered by the brain, which usually begins in late childhood and results in reproductive maturity and completion of [[growth]]. Early puberty may be a [[human variability|variation]] of [[Human development (biology)|normal development]], or may be a result of a [[disease]] or abnormal [[hormone]] exposure. In some contexts, the term is used more broadly to describe the early appearance of any of the physical features of puberty even if the complete brain-directed process is not occurring. ==Types== Early [[pubic hair]], [[breast]], or [[genital]] development may result from natural early maturation or from several other conditions. <blockquote>a.&nbsp;&nbsp;&nbsp;Early puberty which is natural in every way except age is termed ''idiopathic central precocious puberty''. It may be partial or transient. Central puberty can also occur prematurely if the inhibitory system of the brain is damaged, or a [[hypothalamic hamartoma]] produces pulsatile [[gonadotropin-releasing hormone]] (GnRH). <br /><br /> b.&nbsp;&nbsp;&nbsp;Secondary sexual development induced by [[sex steroid]]s from other abnormal sources ([[gonad]]al or [[adrenal]] [[tumor]]s, [[congenital adrenal hyperplasia]], etc.) is referred to as ''peripheral precocious puberty'' or ''precocious pseudopuberty''.</blockquote> ==Clinical significance== Early sexual development deserves evaluation because it may: # induce early [[bone maturation]] and reduce eventual adult height # indicate the presence of a tumor or other serious problem # cause the child to become an object of pedophilia Central precocious puberty can be caused by intracranial neoplasm, infection, trauma, hydrocephalus, and [[Angelman syndrome]]. <ref>{{cite journal |author=Dickerman R, Stevens Q, Steide J, Schneider S |title=Precocious puberty associated with a pineal cyst: is it disinhibition of the hypothalamic-pituitary axis? |journal=Neuro Endocrinol Lett |volume=25 |issue=3 |pages=173–5 |year=2004 |pmid=15349080}}</ref> ;Case Study High levels of beta-hCG in serum and [[cerebrospinal fluid]] observed in a 9-year old boy suggest a pineal gland tumor. The tumor is called a ''chronic [[gonadotropin]] secreting [[pineal]] tumor''. Radiography and chemotherapy reduced tumor and beta-hCG levels normalized.<ref>{{cite journal |author=Kuo H, Sheen J, Wu K, Wei H, Hsiao C |title=Precocious puberty due to human chorionic gonadotropin-secreting pineal tumor |journal=Chang Gung Med J |volume=29 |issue=2 |pages=198–202 |year= |pmid=16767969}}</ref> "Central precocious puberty (CPP) was reported in some patients with suprasellar arachnoid cysts(SAC) [3], and SCFE occurs in patients with CPP because of rapid growth and changes of growth hormone secretion."<ref>European Journal of Pediatrics;March2005,Vol.164 Issue 3, p173-174,2p,1 graph</ref> Bones can be considered older in individuals with early puberty beyond actual age of individual. Early puberty is marked by growth hormone problems resulting from various brain disorders. ==Measures== Studies indicate that breast development in girls and pubic hair in girls and boys are starting earlier than in previous generations.{{Fact|date=June 2008}} As a result, "early puberty" in children as young as 9 and 10 is no longer considered abnormal, although it may be upsetting to parents. No single age limit reliably separates normal from abnormal processes in children today, but the following age thresholds for evaluation will minimize the risk of missing a significant medical problem: * [[Pubic hair]] or genital enlargement in boys with onset before 9 years. * Breast development in boys before appearance of pubic hair and [[testicle|testicular]] enlargement. * Pubic hair before 8 or breast development in girls with onset before 7 years. * [[Menstruation]] in girls before 10 years. ;'''Suggested causes:'''{{Fact|date=October 2007}} # endocrine disorder # familial associations # abnormalities in the ovaries, testicles, or adrenal glands # structural problems in the brain # tumors that release hormones (estrogen, testosterone, etc.) (For Suggested Causes and epidemiology of central form, see: Antoniazzi, F.; Zamboni, G.; "Central Precocious Puberty - Current Treatment Options;" Pediatric Drugs 2004, Vol. 6, No. 4, pp. 211-231) == Causes == The causes of early puberty are not clear. Girls who are obese are more likely to physically mature earlier.<ref>http://www.center4research.org/children11.html</ref> Bisphenol A (BPA) is a chemical used to make plastics, and is frequently used to make baby bottles, water bottles, sports equipment, medical devices, and as a coating in food and beverage cans. Scientists are concerned about BPA's behavioral effects on fetuses, infants, and children at current exposure levels because it can affect the prostate gland or mammary gland, and lead to early puberty in girls. BPA mimics and interferes with the action of estrogen-an important reproduction and development regulator. It leaches out of plastic into liquids and foods, and the Centers for Disease Control and Prevention (CDC) found measurable amounts of BPA in the bodies of more than 90 percent of the U.S. population studied.<ref>http://www.center4research.org/BPA.html</ref> ==Other notes== Medical evaluation is sometimes necessary to recognize the few children with serious conditions from the majority who have entered puberty early but are still medically normal. Precocious puberty can make a child able to conceive when very young; the youngest mother on record is [[Lina Medina]], who gave birth at the age of 5 years, 7 months and 21 days. An 8 year old boy had early puberty caused by a malignant intracranial germ cell tumor. <ref>{{cite journal |author=Massie R, Shaw P, Burgess M |title=Intracranial choriocarcinoma causing precocious puberty and cured with combined modality therapy |journal=J Paediatr Child Health |volume=29 |issue=6 |pages=464–7 |year=1993 |pmid=8286166}}</ref> The role of the pineal gland in reproduction of other species of vertebrate suggest that the pineal gland does have significance in development and function of human reproductive axis.<ref>{{cite journal |author=Cavallo A |title=Melatonin and human puberty: current perspectives |journal=J Pineal Res |volume=15 |issue=3 |pages=115–21 |year=1993 |pmid=8106956 |doi=10.1111/j.1600-079X.1993.tb00517.x}}</ref> In a study using neonatal melatonin on rats, results suggest that elevated melatonin could be responsible for some cases of early puberty.<ref>{{cite journal |author=Esquifino A, Villanúa M, Agrasal C |title=Effect of neonatal melatonin administration on sexual development in the rat |journal=J Steroid Biochem |volume=27 |issue=4-6 |pages=1089–93 |year=1987 |pmid=3121932 |doi=10.1016/0022-4731(87)90194-4}}(4-6):1089-93</ref> == See also == * [[Delayed puberty]] * [[Puberty]] ==References== {{Reflist|2}} ==External links== * [http://www.med.umich.edu/1libr/yourchild/puberty.htm University of Michigan] * [http://www.childgrowthfoundation.org/psm.htm The Child Growth Foundation] *[http://www.center4research.org/children11.html When Little Girls Become Women: Early Onset of Puberty Among Girls] {{Endocrine pathology}} [[Category:Developmental biology]] [[Category:Pediatrics]] [[Category:Sexuality and age]] [[de:Pubertas praecox]] [[es:Pubertad precoz]] [[fr:Puberté précoce]] [[nl:Pubertas praecox]] [[pl:Przedwczesne pokwitanie]] [[pt:Puberdade precoce]]