• Presentor:
Dr. Therese Margareth B. Oquendo
PRECOCIOUS
PUBERTY • Moderator:
• Dr. Paula Cruz-Limlengco
PUBERTY
• marks the normal physiologic transition from childhood to sexual and
reproductive maturity.
• the hypothalamus, pituitary, and ovaries initially undergo a maturation
process which leads to complex development of secondary sexual
characteristics involving the breast, sexual hair, and genitalia
• changes before or after are categorized as either precocious puberty or
delayed puberty and warrant evaluation
•Thelarche
• First physical sign of puberty and beginsatapproximately age 10
(Aksglaed.e, 2009; Biro, 2006)
•Pubarche
• pubic hair growth.
•Growth spurt
• Follow breast and pubic hair growth
• adolescents undergo an accelerated increase in height, termed a,
during a 3-year span from aga 10.5 to 13.5 years
PRECOCIOUS PUBERTY
•defined as breast or pubic hair devdopment
in those younger than 8 years in girls and 9
years in boys
•May be classified as
•Central
•Peripheral
CENTRAL PRECOCIOUS PUBERTY (GONADOTROPIN
DEPENDENT)
•Often termed true precocious puberty or gonadotropin-
depmdent precocious puberty
•Early activation of the hypothalamic-pituitary-ovarian axis >
pulsatile GnRH secretion > increased gonadotropin
production > higher sex steroid levels
PERIPHERAL PRECOCIOUS PUBERTY
(GONADOTROPIN INDEPENDENT)
•Termed peripheral precocious puberty or
gonadotropin-independent precocious puberty
•characterized by lack of GnRH pulsatile release
•low levels of pituitary gonadotropins
•elevated serum estrogen concentrations
HETEROSEXUAL
PRECOCIOUS PUBERTY
•Termed heterosexual precocious puberty
•increased androgen secretion in young females
from the adrenal gland or ovary.
•causes include:
• androgen-secreting ovarian or adrenal tumors
• congenital adrenal hyperplasia
• Cushing syndrome
• exposure to exogenous androgens.
EVALUATION
•HISTORY
•Age of onset
•Sex
•Pubertal progression
•Rule out life-threatening neoplasms of
the ovary, adrenal gland, or CNS
BONE AGE
•average age at which children in general reach a
particular stage of bone maturation
• Girls with early estrogen excess from precocious puberty
• growth-rate acceleration
• rapid bone-age advancement
• early epiphyseal closure
➢ Short stature
•Pelvic sonography : Uterine length >3.5 cm
•indicates estrogen exposure
•multifollicular ovaries reflect central stimulation
•serum FSH, LH, and estradiol levels are
elevated for chronologic age and typically lie in
the pubertal range.
EVALUATION
PHYSICAL EXAMINATION
•Measurement of height &
weight
•Tanner staging
•Evaluate androgen and
estrogen effects
•Inspection of skin (caufe-au-
lait macules in McCune-
Albright Syndrome)
HORMONE EVALUATION
•GnRH stimulation test
•Leuprolide stimulation test
•Levels of estradiol 20-24 hour after
leuprolide stimulation
TREATMENT
•GOAL:
•Reduce gonadotropin secretion
•Reduce or counteract the peripheral
actions of the sex steroids
•Decrease the growth rate to normal
•Slow skeletal maturation to allow
development of maximal adult
TREATMENT
•GNRH AGONIST
•Leuprolide injection
•SURGERY
•Surgical removal of tumors of the
ovary, testis and adrenals
