PRECOCIOUS PUBERTY

DEFINITION

 Development of secondary sexual

characteristics before
 8 years old in Girl
 9 years old in Boy

• It is much commoner in girls compared to boys

(F:M ratio 5:1)
• 80% of cases are not related to pathological
causes in girls, whereas 80% have pathological
causes in boys.
CLASSIFICATION

1. TRUE Precocious Puberty (PP)

 Gonadtropin-dependent from premature
activation of hypothalamic-pituitary-gonadal
axis.

2. FALSE Precocious Puberty (pseudopuberty)

 Gonadtropin-independent from excessive sex
hormone.
CAUSES

1. TRUE PP
 Idiopathic
 Secondary to trauma, tumours, hemorrahge
,hydrocephalus, neurofibromatosis, primary
hypothyrodism (the only cause of precocious
puberty with short stature and delayed bone
age)
CAUSES

2. FALSE PP
- Adrenal: Cushing Syndrome, Congenital
Adrenal Hyperplasia, and tumors

- Gonadal : Ovarian cyst/tumor (e.g

granulosa cell). Testicular tumor (e.g Leydig
cell tumor. McCune- Albright syndrome (café
au lait spots, polyostotic fibrous dysplasia
and precocious puberty which cause by
primary ovarian cyst)
- Ectopic : Gonadotrophin secreting tumor (e.g
Hepatoblastoma , Dysgerminoma).
Exogenous hormone administration (e.g
ingestion of birth control pills)
Workout

 FSH, LH (high in True PP, low in False PP)

 Oestradiol , testosterone
 Adrenal hormones ( cortisol , 17-OH-
progesterone )
 Imaging (skull xray, MRI, pelvis ultrasound
and bone age)
Others:

 Isolate premature thelarche (isolated premature

breast enlargement ) cause by ovarian cysts ,
there is no other sign of puberty. It is non-
progressive and self limiting, investigations
usually not required.

 Pubertal Gynaechomastia is common in boys

passing through puberty, and usually coincides
with Tanner stages III and IV. It is caused by
increase in oestrogen/ androgen ratio.
 Premature Adrenache (isolated pubic hair
development): pubic hair develops before age
of 8y/o in girls and before 9y/o in boys but
with no other sign of sexual developmental.
MANAGEMENT

 Detection and treatment of any underlying

pathology e.g. intracranial tumor in males.
 Addressing psychological/behavioral
difficulties associated with early progression
through puberty.
 Treatment for
 gonadotropin-dependent disease->
gonadotropin-releasing hormone (GnRH)
analogue .
 Gonadotropin-independent -> the source of
excess sex hormone need to be identify .
Inhibitors of androgen or oestrogen production
(e.g medroxyprogesterone acetate, cyproterone
acetate, testolactone, ketocanazole) .
THANK YOU FOR YOUR ATTENTION

THE END