Introduction:
Central precocious puberty is precious puberty characterized by the early onset of puberty in girls and boys. Although the specific cause of central precocious puberty is unknown. However, obesity and exposure to endocrine-disrupting substances are thought to play a role in developing central precocious puberty. Symptoms of the condition include the appearance of general features of puberty before the average age of puberty. Precocious puberty, if left untreated, can result in short stature and significant psychological and behavioral problems.
What Is Puberty?
Puberty refers to the process by which a child's body matures into an adult and becomes capable of sexual reproduction. Multiple hormones, including gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH), induce puberty. The hypothalamic-pituitary-gonadal axis (combined functioning of the hypothalamus, pituitary gland, and gonads) regulates reproductive functioning and immunity in an individual. Therefore, it is required for the onset of puberty. The hypothalamus secretes the gonadotropin-releasing hormone. The pituitary gland responds by secreting gonadotropin hormones, which promote the growth of the testes and ovaries in boys and girls, respectively. During childhood, the hormones responsible for the beginning of puberty are dormant or inactive.
What Is Precocious Puberty?
Precocious puberty can be defined as early-onset or puberty starting before the average age of attaining puberty. The conventional definition of precocious puberty is the growth of secondary sexual characters in girls before the age of eight and in boys before nine. Precocious puberty is characterized by the early development of breasts in girls and testes in boys, the appearance of pubic hair, and the growth of the reproductive organs or genitalia in both genders. Precocious puberty affects approximately one in 5,000 to one in 10,000 children worldwide. Females are more likely to develop precocious puberty as compared to males.
What Are the Types of Precocious Puberty?
Precocious puberty is broadly classified into three categories based on its cause:
Central Precocious Puberty: Early maturation and stimulation of the HPG axis lead to central precocious puberty. Sex hormones are released too early during this type of precocious puberty.
Peripheral Precocious Puberty: It is the early development of secondary sexual characteristics in a child irrespective of growth hormone-releasing hormone secretion. Problems with the reproductive organs or the adrenal glands and hormone exposure from the environment can cause peripheral precocious puberty. This type of precocious puberty is caused by estrogen or testosterone in the child's body.
Incomplete Precocious Puberty: Incomplete puberty occurs when a child exhibits just a few signs and symptoms of precocious puberty.
What Is Central Precocious Puberty?
Central precocious puberty is a type of precocious puberty. The development of secondary sexual characters and other pubertal growths starts early due to maturation and activation of the HPG axis (hypothalamic-pituitary-gonadal). In the case of central precocious puberty, there is a release of sexual hormones ahead of their usual time. Central precocious puberty starts before the age of eight to 13 in girls and before the age of nine to 14 in boys.
What Are the Other Names of Central Precocious Puberty?
Alternative names of central precocious puberty are as follows:
- Gonadotropin-dependent precocious puberty.
- CPP.
What Causes Central Precocious Puberty?
Central precocious puberty occurs due to the following reasons:
- The exact cause of central precocious puberty is often unknown.
- Mutations in the MKRN3 gene (makorin ring finger protein 3) are the most prevalent genetic cause of central precocious puberty. The MKRN3 gene produces a protein that helps to regulate the start of puberty. According to studies, the MKRN3 protein inhibits GnRH release from the hypothalamus, therefore delaying puberty.
- Child obesity may also cause central precocious puberty.
- Central nervous system tumors like hypothalamic hamartoma (tumor-like growth on the hypothalamus), optic glioma (tumors affecting one or both of the optic nerves), pineal tumors (tumors developing in the pineal region, etc.
- An injury like head trauma, cerebral palsy, and infections tuberculous meningitis.
- Syndromes like tuberous sclerosis and neurofibromatosis type 1.
- Withdrawal from sex hormone replacement therapy.
- Family history of precocious puberty.
- Radiation therapy or chemotherapy for cancer.
Is Central Precocious Puberty a Common Condition?
- Central precocious puberty is ten times more prevalent in girls than boys.
- The African-American race is more affected by central precocious puberty.
- The exact incidence of central precocious puberty is unknown, but a study suggested that 23 out of every 1000 girls and 5 out of every 1000 boys can develop central precocious puberty.
- Central precocious puberty is a hereditary condition which means the condition can be transferred from parents to their children. When inherited, the condition is called familial central precocious puberty.
What Are the Signs and Symptoms of Central Precocious Puberty?
The symptoms of central precocious puberty are:
- Early development of breasts in girls.
- Growth of testes and increased testicular volume in boys.
- Increased in height.
- Muscular growth and changes.
- Acne.
- High adult body odor.
- Development of pubic hair.
- Development of axillary hair.
- Start of menstruation in girls.
- Mood swings and emotional changes.
- Growth of facial hair in boys.
How Is Central Precocious Puberty Diagnosed?
Clinical, biochemical, and radiographic assessments diagnose central precocious puberty. It is diagnosed in the following ways:
- Bone age evaluation is done. Further testing should be done if the bone age is greater than the chronological age.
- The levels of various hormones like luteinizing hormone, follicle-stimulating hormone, testosterone, progesterone, estrogen, etc., are checked. Hormonal testing is used to distinguish between peripheral and central precocious puberty.
- A thyroid function test is done to assess the functioning of the thyroid gland.
- Imaging tests like CT scans (computed tomography) and MRI (magnetic resonance imaging) are done to check for the presence of any tumor.
How Is Central Precocious Puberty Treated?
- In most cases, central precocious puberty does not require any treatment. Moreover, the need to give treatment also depends on the child's age and the degree of progression of puberty.
- Treatment should be considered if the child's symptoms quickly increase or their bone age is greatly advanced.
- The primary treatment goals are maintaining adult height while reducing psychological stress.
- GnRH antagonist therapy is a safe therapy used to treat central precocious puberty. In this treatment modality, doctors employ a medication to inhibit the further development of puberty by blocking sex hormones. GnRH is a synthetic hormone that prevents the pituitary gland from secreting gonadotropins.
- Periodic pubertal development, growth rate, and bone maturation monitoring are required while on therapy.
Conclusion:
Central precocious puberty is not a severe condition; it can be treated and has a good prognosis. Early treatment is linked to a better chance of attaining final adult height. Various parameters, including the rate of bone growth, the timing of beginning, and the duration of therapy, determine the outcome.
