Early (Precocious) Puberty

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Introduction

Early puberty is defined as secondary sexual characteristics beginning < age 8 in girls or < age 9 in boys.

It is more common in females but uncommon in males.

 

 

 

 

The Case of...

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Differential Diagnosis

Potential causes of precotious puberty include:

hypothalamus-pituitary

  • hypothalamic hamartoma is most common
  • astrocytoma, glioma, teratoma
  • post-meningitis
  • radiotherapy
  • neurofibromatosis

 

adrenal

gonads

  • gain of function mutations in LH receptor, G proteins
  • testicular or ovarian tumour
  • gonadotropin-secreting tumour

other

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History and Physical Exam

  • history
  • physical exam

History

history: symptoms of puberty, family history

Physical Exam

physical exam: growth curve, Tanner staging, neurological exam

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Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

labs: testosterone, LH, FSH, TSH, GnRH tests

Do GnRH stimulation testing to determine if is gonadotropin dependent (LH/FSH will increase) or independent (no change).

Examine testosterone, 17-hydroxyprogesterone - elevated in CAH

Diagnostic Imaging

Do brain imaging (MRI) on any girl under 6 years of age, or any boy presenting with precocious puberty.

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Management

Central: GnRH agonists such as leuprolide

Peripheral: ketoconazole, 5-alpha reductase blockers, steroid receptor blockers, aromatase blockers

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Pathophysiology

 

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Resources and References

 

 

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Topic Development

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