What are the concerns about the puberty timing?
Two aspects of puberty of concern:
- Precocious puberty: <8 years in girls; <9 years in boys
- Delayed puberty: >12 years in girls; >14 years in boys
Why do some bloom early?
It can be due to various reasons like nutritional issues (obesity) or abnormally high hormones from the brain which stimulates the ovaries in girls or Testes in boys respectively. Sometimes extra hormones can come from Adrenal Glands which can kick start puberty early.
What are the variations in pubertal development?
They are of three different types. They actually do not denote precocious puberty and hence can be considered as normal variations only.
They are premature thelarche (early breast enlargement without other signs), premature menarche (early periods without other signs) and premature adrenarche (early development of pubic and underarm hair without other signs).
What are the implications of precocious puberty?
Precocious puberty is associated with both psychological and physiological implications. Psychologically the child is too young to adjust to the new situation.
Physiologically it has a bearing on the ultimate height reached by the child. Although puberty is associated with initial growth spurt it ultimately causes early fusion of the bones thus reducing the final height and causing short stature.
Precocious puberty can lead to unwanted sexual abuse and pregnancy.
What are the tests to be done?
Certain hormone tests are done to know the blood levels of the hormones concerned with puberty. If it is found to be abnormal, a stimulation test called GnRH stimulation test is performed. In this test the hypothalamic hormone, GnRH is injected and the pituitary hormones are measured at 30 & 60 minutes.
Seeing the pattern of these hormones one can diagnose precocious puberty. MRI scan of the brain and the adrenals are also requested in order to look at the structural lesions of these glands.
What is the treatment for central precocious puberty?
We have now medicines available which can suppress pituitary FSH/LH secretion and postpone puberty. Good news is that we can avoid giving injection daily and use monthly or 3 monthly injections. This medicine is safe and doesn’t have any major side effect pertaining to future reproductive capacity of the child. At the appropriate time, we can stop and normal puberty will continue.
How long do we give these injections?
They need to be given at least until the normal age of puberty ie 12 yrs.
Are there any side effects with this drug on long term basis?
No. Some may develop allergic reactions and rarely mild reduction in bone mineral density. Hence increased dietary calcium supplementation may be necessary.
What is the normal age of puberty?
While girls enter the puberty at an average age of 10-12 yrs boys do so when they are around 12-14 years. A certain feature like genes, race, weight gain and overall nutrition determine the age of onset of puberty.
The completion of the maturation process is rather wide and it may take 4 to 6 years.