What causes precocious puberty? After menarche, girls grow an average of 7 cm.14,1418, Precocious puberty is diagnosed when secondary sexual characteristics are identified in girls younger than eight years and boys younger than nine years.5,6 Data suggest a trend toward early pubertal development. Several possible causes for the recent rapid increase in the reported incidences of precocious puberty and medical treatment for it have been proposed, including increases in childhood obesity, opportunities to exposure to sexual stimulation through TV and the Internet, environmental hormones caused by environmental pollution, and parental focus on child development [3,4]. All subjects voluntarily agreed to participate in the study after receiving a detailed description of the procedures and goals. Pinyerd B., Zipf W.B. Li X, Zhang X, Shen Z, Chen Z, Wang H, Zhang X. Int J Med Sci. p-Value determined by analysis of variance test (continuous variables) or 2 test (categorical variables). The less common peripheral precocious puberty occurs without the involvement of the hormone in your brain (GnRH) that normally triggers the start of puberty. The pattern of endocrine change, in centrally mediated precocious puberty, is the same as in normal puberty (i.e., pubertal development is consonant). Causal arrows are difficult to draw, however. History and physical examination should be followed by measurements of serum follicle-stimulating hormone, luteinizing hormone, and testosterone (boys) or estradiol (girls); thyroid function testing; and bone age radiography. Precocious puberty. Metab. Investigating the relationship between precocious puberty and obesity: a cross-sectional study in Shanghai, China. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. This is the most common type of precocious puberty. . No one knows what risk factor or more likely, what combination of factors is driving the age decline or why there are stark race- and sex-based differences. One reason for the rapid increase in precocious puberty is the consumption of high-calorie, high-fat foods; these habits are also closely related with childhood obesity. The comparisons of family composition and socioeconomic status among the three groups are shown in Table 2. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Declining age of puberty of school girls in southern Thailand. And for unclear reasons, doctors across the world have reported a rise in early puberty cases during the pandemic. An article published in the Journal of Pediatric and Adolescent Gynecology, in May, found that early puberty put girls at higher risk for obesity, type-2 diabetes, breast cancer, and heart disease . Phthalates belong to a broader class of chemicals called endocrine disrupters, which can affect the behavior of hormones and have become ubiquitous in the environment over the past several decades. The scale defines normal puberty as starting at age 8 or above for girls and age 9 or above for boys. Review and evaluation of patient-centered psychosocial assessments for children with central precocious puberty or early puberty. This study aimed to evaluate environmental and dietary factors that affect obesity in children with precocious puberty and to identify key points in health management. The demographic characteristics and clinical factors of the subjects are presented as means standard deviation for continuous variables and as frequencies with percentages for categorical variables. 2013. An ALT level was significantly higher in the obesity group than in the normal group (p = 0.005), but both groups remained in the normal range. central precocious puberty caused by a CNS tumor Prognosis Majority of girls who experience precocious puberty at ages 6-8 years will achieve an average adult height without treatment extent of improvement in adult height compared with predicted height at start of treatment is correlated with the age of onset of precocious puberty Obesity: Excess weight and obesity is linked to early onset of menstruation in girls and early puberty in boys. Family composition and socioeconomic status according to obesity status. Eugster E.A. Would you like email updates of new search results? Licensee MDPI, Basel, Switzerland. Growth patterns, such as constitutional delay, may be familial. In girls, precocious puberty may be caused by the early maturity of the hypothalamus, pituitary glands and ovaries. This study was approved by the Institutional Review Board of Soonchunhyang University, Bucheon Hospital (IRB number 2017-07-004). Data Sources: A PubMed search was completed using the MeSH function with the key term puberty and at least one of the following qualifiers: early, precocious, delayed, absent, or disorder. If abnormal growth velocity is a concern, serum thyroid function, prolactin, and insulinlike growth factor I should be assessed.7 Constitutional delay of growth and puberty can be difficult to distinguish from persistent hypogonadotropic hypogonadism; the latter may be diagnosed at 18 years of age if there is inadequate response to jump-start therapy (which is defined later in this section), and sex steroid replacement is still required.7,45, Bone age indicates the degree of sex steroid effect on bone maturation and future growth potential.7,9 For example, patients with constitutional delay of growth and puberty generally have a delay of more than two years, but this finding is nonspecific.8. The comparisons of body cognition and parents health status are shown in Table 3 and Figure 1. . 2022 Aug 25;2022:8325756. doi: 10.1155/2022/8325756. ; supervision, H.-S.L. Effects of exogenous oestrogens. Of the 193 children, 13 were boys (6.7%) and 180 were girls (93.3%). Precocious puberty is rare and has a clear female predominance. The nutrition quotients (NQs) were revealed to be significantly lower in the obese group with significantly lower scores. Because childrens eating behavior is affected by family environmental variables, eating habits that contribute to their parents obesity and disease-inducing behaviors may also be related. Blood test results, performed at diagnosis, reviewed by a retrospective survey of medical records included aspartate aminotransferase (AST), alanine aminotransaminase (ALT), glucose, and total cholesterol for the screening of the comorbidities. The median ages of breast, pubic hair and testicle development decreased with BMI increase and median ages of thelarche and testicular development rather than pubarche were earlier in children with central obesity. This study had several limitations. However, unlike previous studies, it is meaningful that the evaluation of body image was analyzed according to obesity degrees in children with precocious puberty, the relationship with parental variables was investigated, and the problems with eating habits were identified. As a subscriber, you have 10 gift articles to give each month. In 2008, it was almost 20%. Other variables assessed by the questionnaire included family composition and socioeconomic status, subjective awareness and satisfaction of body shape, parents health status, and dietary quality and food behavior. Precocious puberty is more serious than the expense of . Although it is difficult to tease apart cause and effect, earlier puberty may have harmful impacts, especially for girls. Among patients with true precocious puberty, or full activation of the hypothalamic-pituitary-gonadal axis, most girls have an idiopathic etiology, whereas it is commonly due to identifiable pathology on imaging in boys. Isolated prepubertal vaginal bleeding not caused by trauma, abuse, a foreign body, infection, or an exceedingly rare tumor is usually benign.6,28, Premature adrenarche, driven by adrenal androgens rather than activation of the HPG axis, leads to slowly progressive appearance of pubic and axillary hair, body odor, sweating, and/or mild acne without change in linear growth velocity or enlargement of the testes, penis, breasts, ovaries, or clitoris. . Accessed Feb. 20, 2019. Conversely, the less affection from the parent, the more the childs behavior is likely to become negative [28]. A total of 193 children (93.3% girls) diagnosed with precocious puberty were classified into three groups according to their obesity levels. But the evidence that they are driving earlier puberty is murky. An analysis of childrens body satisfaction revealed that the proportion who were satisfied or very satisfied was 46.2%, but satisfaction was significantly lower in the overweight group (p < 0.001). An LH level of more than 0.3 mIU per mL (0.3 IU per L) is the most reliable laboratory finding for central precocious puberty; however, in patients with lower values and high clinical suspicion, a gonadotropin-releasing hormone analogue stimulation test may be warranted.6,34 In cases of diagnostic uncertainty, pelvic ultrasonography can evaluate for increased uterine and ovarian volume expected for age, which may indicate central precocious puberty or a tumor.6, The appropriate timing for neuroimaging to identify central nervous system lesions (e.g., hypothalamic hamartoma, malignancy) in children with precocious puberty is controversial. The clinician should inquire about the onset and progression of body odor, acne, breast or testicular development, and pubic and axillary hair. The data are presented as the mean standard deviation. Patient information: See related handout on early and delayed puberty. Pediatrics. What kind of tumors cause precocious puberty? Evid Based Complement Alternat Med. Selecting items of a food behavior checklist for the development of Nutrition Quotient (NQ) for children. Puberty is a developmental stage characterized by physical and psychosocial maturation. Mayo Clinic is a not-for-profit organization. Jackson P.L., Ott M.J. In a 2009 study of nearly 1,000 school-aged girls in Copenhagen, his team found that the average age of breast development had dropped by a year since his earlier study, to a little under 10, with most girls ranging from 7 to 12 years old. Chan School of Public Health and a co-author of the analysis. In hypergonadotropic hypogonadism, gonadal insufficiency delays puberty and results in elevated levels of FSH and LH. ); rk.ca.cmhcs@nihsly (Y.-L.S. Rosenfield R.L., Cooke D.W., Radovick S. Puberty and its disorder in the female. Obesity is reported to be closely relevant to early sexual development but the relationship between sexual precocity and obesity or central obesity is still inconsistent, especially in boys. 1, normal group; 2, overweight group; 3, obesity group. A 2 test was performed to compare rates. Accessed March 7, 2019. But some experts argue that the age threshold for alarm should be lowered. Correlation between childrens body mass index (BMI) z-score and parents BMI. Precocious puberty has been reported to cause anxiety due to the physical changes, dissatisfaction with changes in body shape, loneliness, and other negative psychological effects [22]. Nutrition during prepuberty, and even during infancy and childhood, has a significant impact on pubertal development, and several studies have reported that pubertal development is more rapid in obese children [5,6,7]. I dont think theres much controversy that obesity is a major contributor to early puberty these days, said Dr. Natalie Shaw, a pediatric endocrinologist at the National Institute of Environmental Health Sciences who has studied the effects of obesity on puberty. Unable to load your collection due to an error, Unable to load your delegates due to an error. ; writingreview and editing, H.-S.L. In patients with precocious puberty, brain magnetic resonance imaging should be performed in girls younger than six years, all boys, and children with neurologic symptoms to evaluate for a central nervous system lesion. Overweight/Obesity in Childhood and the Risk of Early Puberty: A Systematic Review and Meta-Analysis. Functional hypogonadotropic hypogonadism is caused by chronic disease, stress, or inadequate nutrition, and the condition may be transient or reversed. The fathers BMI showed a significant correlation with the childs BMI (r = 0.199, p = 0.006). Why this process begins early in some children depends on whether they have central precocious puberty or peripheral precocious puberty. Does self-esteem affect body dissatisfaction levels in female adolescents? Awareness of and satisfaction with a childs body shape by both the child and their parents has been studied in previous research [13,14]. The most common educational level was represented by families in which both parents were college graduates; there was no significant difference among the three groups. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association between precocious puberty and general obesity and central obesity. What causes precocious puberty? But, there are things you can do to reduce your child's chances of developing precocious puberty, including: Mayo Clinic does not endorse companies or products. the display of certain parts of an article in other eReaders. Subsequently, multinomial logistic regression analyses were performed to evaluate factors affecting obesity status. Patients with precocious puberty who were found to have underlying causes, such as brain tumors, thyroid abnormalities, ovarian tumors, or other disease, were excluded. Others, like Dr. Herman-Giddens, say that the changes are a sign of a legitimate public health problem and should not be accepted as normal. Williams V.S.L., Soliman A.M., Barrett A.M., Klein K.O. Although the fundamental cause of this could not be determined, it is generally considered that parents concern about their childrens symptoms and prognosis also affected the childrens body shape awareness or satisfaction. Boys 14 years and older and girls 13 years and older may benefit from sex steroid treatment to jump-start puberty. However, these cases are rare. There was no significant difference in the percentage of fathers with chronic diseases among the three groups, but fathers of children in the obese group had the highest rate of such diseases. The nutrition quotients (NQs) for children developed by the Korean Nutrition Society is widely used in nutrition research with Korean children, as it can comprehensively evaluate childrens nutritional status by examining their dietary quality, nutrient intake, and dietary behavior through a survey [15,16,17]. Karlberg J. Secular trends in pubertal development. Sparse, long, slightly pigmented, straight or slightly curled, along the medial labia, Breasts and areolae are further enlarged with a continuous rounded contour, Darker, coarser, more curled, spread sparsely over the mons pubis, Areola and nipple form a secondary mound above the contour of the breast, Adult type, but the area covered is smaller and there is no extension to the medial thighs, Mature adult stage, nipple projection without the secondary mound, Adult type and quantity, sometimes extending to the medial thighs, Enlargement of the testes (more than 4 mL in volume and more than 2.5 cm in length) and scrotum, but not the penis, Sparse, long, slightly pigmented, straight or slightly curled, at the base of the penis, Continued testicular and scrotal enlargement with penile growth, Darker, coarser, more curled, spread sparsely over the pubis, Continued testicular, scrotal, and penile growth with enlargement of the glans, Adult type but the area covered is smaller and there is no extension to the medial thighs or linea alba, Peak height velocity, spermarche, facial hair, voice change, Adult quality and distribution with spread to the medial thighs, Body mass index and weight (growth charts), High: may be associated with precocious puberty, McCune-Albright syndrome, neurofibromatosis, Pubertal growth spurt, pathologic growth due to an underlying condition, Hyperandrogenism: premature adrenarche, peripheral precocious puberty, Neurologic assessment (abnormal examination findings, or symptoms such as headaches or vision changes), Temperature intolerance, gastrointestinal symptoms, tremor, depression, palpitations, Benign variant, genital trauma or abuse, foreign body, infection, McCune-Albright syndrome, Androgen-secreting tumor, congenital adrenal hyperplasia, Body mass index and weight (on growth charts), Low: eating disorder, caloric insufficiency, gastrointestinal or other systemic disease, Chemotherapy, radiation treatment, brain tumor, Dysmorphic features (webbed neck, short stature, low hairline), Constitutional delay of growth and puberty, Peripubertal growth slowing, pathologic growth due to underlying condition, Short stature: Turner syndrome, constitutional delay of growth and puberty, Neurologic assessment (abnormal examination findings or symptoms such as headaches, vision changes), Red (vs. dull pink) or thin vaginal mucosa, Delayed pubertal development (unspecified), Weight loss, stress, excessive exercise, inadequate nutrition, fatigue, Fat tissue but no glandular breast tissue on palpation; associated with obesity, Early but normal sequence of pubertal events that does not progress prematurely, Surveillance every 3 to 6 months to evaluate for progression of pubertal development, Pubic and axillary hair growth, body odor, sweating, and/or mild acne; may have mildly elevated dehydroepiandrosterone sulfate, but normal levels of FSH, LH, 17-hydroxyprogesterone, estradiol, and testosterone; no change in linear growth velocity or enlargement of the testes, penis, breasts, ovaries, or clitoris, Surveillance every 3 to 6 months to evaluate for progression of pubertal development; linear growth velocity should be normal (i.e., consistent with bone age), Glandular breast tissue on palpation (as opposed to lipomastia) without other secondary sexual characteristics, Absence of secondary sexual characteristics, genital trauma or abuse, foreign body, infection, evidence of McCune-Albright syndrome; possible ovarian enlargement on ultrasonography, Surveillance for heavy or recurrent bleeding, Central nervous system lesion (e.g., hypothalamic hamartoma), radiation, trauma, Early but normal sequence of pubertal events; possible magnetic resonance imaging abnormalities, Treatment of underlying cause, which may involve GnRH analogue, Early but normal sequence of pubertal events; possible reproductive organ enlargement on ultrasonography (unlike premature thelarche), Prior sex steroid exposure (e.g., peripheral precocious puberty), Early but normal sequence of pubertal events with suggestive history, Pubic or axillary hair growth, possibly acne and clitoromegaly; prepubertal testes; elevated adrenal hormone (e.g., dehydro-epiandrosterone sulfate); adrenal imaging abnormalities, Pubic or axillary hair growth, possibly acne and clitoromegaly; prepubertal testes; elevated adrenal hormone (e.g., 17-hydroxy-progesterone), Referral to a pediatric endocrinologist for multisystem treatment and surveillance, Exposure to contraceptives, testosterone preparations, phthalates, or lavender tree oil, Elevated thyroid-stimulating hormone, breast or testicular development, Multiple caf au lait spots and fibrous dysplasia of bones, ovarian enlargement or testicular abnormalities on ultrasonography; may have menstrual bleeding before other development, May be apparent on physical examination or imaging and accompanied by elevated serum testosterone or estradiol; human chorionic gonadotropinsecreting germ cell tumors activate testes in boys; may occur outside of the gonads, Treatment of the tumor; ovarian tumor should be differentiated from a benign ovarian cyst, Elevated (girls): estrogen exposure; if markedly elevated (> 100 pg per mL [367 pmol per L]), evaluate for ovarian tumor, especially if luteinizing hormone is suppressed, Low (girls): prepubertal, may suggest poor ovarian function in response to gonadotropins, Elevated: testicular (boys), adrenal, or exogenous source, Low (boys): prepubertal, poor response of testes to gonadotropin stimulation, Serum LH and follicle-stimulating hormone, Prepubertal levels: benign variant or peripheral precocious puberty, High: gonadal insufficiency, Turner syndrome, Klinefelter syndrome, Postpubertal levels > 0.3 mIU per mL (0.3 IU per L): central precocious puberty, Low: hypogonadotropic hypogonadism, constitutional delay of growth and puberty, Directed testing (e.g., for celiac disease; diabetes mellitus; or hepatic, renal, or inflammatory conditions), Functional hypogonadotropic hypogonadism, seek underlying cause, Gonadotropin-releasing hormone analogue stimulation test, Elevated LH: central precocious puberty (vs. benign variant) in complex clinical scenarios, Suppressed LH but elevated sex steroids: peripheral precocious puberty, Elevated: nonclassic (late onset) congenital adrenal hyperplasia, Elevated: adrenal source, premature adrenarche (mild elevation) vs. peripheral precocious puberty, Normal for age: may suggest persistent hypogonadotropic hypogonadism rather than constitutional delay of growth and puberty, Serum human chorionic gonadotropin (boys), Elevated: human chorionic gonadotropinsecreting germ cell tumor, Low: growth hormone deficiency (if low for both bone and chronologic age), High: prolactin-secreting tumor, hypothyroidism, other neoplasm, Serum thyroid-stimulating hormone and free thyroxine, Advanced (> 2 standard deviations): more likely to be central or peripheral precocious puberty, less likely to be benign pubertal variant, Delayed: constitutional delay of growth and puberty, underlying chronic disease, Magnetic resonance imaging (brain and pituitary), Ovarian or testicular tumor; greater ovarian volume may indicate central precocious puberty (vs. benign variant), Absence of the uterus (e.g., androgen insensitivity, Mllerian system abnormalities), Normal growth velocity, history of delayed puberty in parents, delayed bone age, Surveillance every 6 months to evaluate for progression of pubertal development, Abdominal pain, malabsorption, anemia, poor weight gain; short stature may be the only symptom; positive serology results, confirmed with endoscopic biopsy, Polyuria, polydipsia, polyphagia, weight loss, or known but poorly controlled disease; confirmed by serology, Weight loss, heat intolerance, insomnia, tachycardia, hypertension; confirmed with serology, Weight gain, cold intolerance, fatigue, bradycardia; confirmed with serology, Inadequate nutrition for metabolic needs (e.g., eating disorder), Weight loss or poor weight gain, excessive exercise, food restriction, purging, Weight restoration, treatment of underlying disorder, Abdominal pain, constipation, diarrhea, hematochezia, poor weight gain, elevated serum erythrocyte sedimentation rate and C-reactive protein; confirmed with endoscopic biopsy, Gonadotropin-releasing hormone deficiency, bilateral cryptorchidism, micropenis, unilateral renal agenesis, synkinesis (mirror movements), cleft lip or palate, hearing loss, dental agenesis, skeletal malformations, Referral to a pediatric endocrinologist for hormone therapy, Anosmia in addition to congenital hypogonadotropic hypogonadism presentation, History of trauma, surgery, or CNS radiation for prior malignancy; may present similarly to CNS tumor if acute, Referral to a pediatric endocrinologist for hormone therapy; other referrals as necessary for treatment of underlying disease, Headaches, vision changes, seizures, suggestive magnetic resonance imaging findings of the brain and pituitary, Referral for diagnosis and treatment of underlying disease (e.g., neurosurgeon, endocrinologist), Chemotherapy, radiation, or trauma to gonads, Tall stature, learning disabilities, relatively small testes (3 to 6 mL) for degree of androgenization; 47,XXY karyotype, Short stature, facial dysmorphism, webbed neck, brachydactyly, heart defects; in cases of mosaicism, short stature may be the only sign; 45,X or related karyotype, Referral to a pediatric endocrinologist for hormone therapy and other comprehensive care, Any pubertal changes before 6 years of age in girls and 9 years of age in boys, Pubertal changes with associated headaches, vision changes, new-onset seizures, Confirmed central or peripheral precocious puberty (not a generally benign variant), Known predisposing conditions (e.g., neurofibromatosis, previous irradiation, known neoplasm), Boys without testicular growth to at least 4 mL in volume or 2.5 cm in length by 14 years of age, Girls without breast development by 13 years of age.
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