Puberty is when your body changes from that of a child into an adult. It includes rapid growth of bones and muscles, changes in body shape and size, and development of your body's ability to reproduce.
Puberty normally begins in girls between ages 8 and 12 and in boys between ages 9 and 14. Precocious puberty is puberty that begins before age 8 for girls and before age 9 for boys.
The cause of precocious puberty often can't be found. Rarely, conditions such as infections, hormone disorders, tumours, brain abnormalities or injuries may cause precocious puberty. Treatment for precocious puberty typically includes medication to delay further development.
Symptoms
Signs and symptoms of precocious puberty include development of the following before age 8 in girls and before age 9 in boys.
Girls:
Breast growth
First period (menstruation)
Boys:
Enlarged testicles and penis
Facial hair (usually grows first on the upper lip)
Deepening voice
Both girls and boys:
Pubic or underarm hair
Rapid growth
Acne
Adult body odour
When to see a doctor Make an appointment with your grandchild's doctor for an evaluation if your grandchild has any of the signs or symptoms of precocious puberty
Causes
To understand what causes precocious puberty in some grandchildren, it's helpful to know what causes puberty to begin. A complex process known as the hypothalamic-pituitary-gonadal (HPG) axis governs when puberty occurs. This process involves the following steps:
Your brain starts the process. Part of your brain called the hypothalamus makes gonadotropin-releasing hormone (Gn-RH).
The pituitary gland releases more hormones. Gn-RH causes your pituitary gland — a small bean-shaped gland at the base of your brain — to release two more hormones: luteinizing hormone (LH) and follicle-stimulating hormone (FSH).
Sex hormones are produced. LH and FSH cause the ovaries to produce hormones involved in the growth and development of female sexual characteristics (estrogen) and the testicles to produce hormones responsible for the growth and development of male sexual characteristics (testosterone). The adrenal glands also begin to make estrogen and testosterone.
Physical changes occur. The production of estrogen and testosterone causes the physical changes of puberty.
The reason this process begins early in some children depends on the type of precocious puberty they have: central precocious puberty or peripheral precocious puberty.
Central precocious puberty There's usually no identifiable cause for this type of precocious puberty.
In central precocious puberty, the entire HPG axis starts too soon. Although they begin earlier than they should, the pattern and timing of the steps in the process are otherwise normal. For the majority of children with this condition, there's no underlying medical problem and no identifiable reason for the HPG axis to begin when it does.
In rare cases, the following may cause central precocious puberty:
A tumour in the brain or spinal cord (central nervous system)
An infection, such as encephalitis or meningitis
A defect in the brain present at birth, such as excess fluid build-up (hydrocephalus) or a noncancerous tumour (hamartoma)
Radiation to the brain or spinal cord
Injury to the brain or spinal cord
An obstruction of blood flow to the brain (ischemia)
McCune-Albright syndrome — a genetic disease that affects bones and skin colour and causes hormonal problems
Congenital adrenal hyperplasia — a group of inherited disorders involving abnormal hormone production by the adrenal glands
Hypothyroidism — a condition in which the thyroid gland doesn't produce enough hormones
Peripheral precocious puberty Estrogen or testosterone in your grandchild's body causes this type of precocious puberty.
Peripheral precocious puberty, which is less common than central precocious puberty, happens without involvement of Gn-RH. Instead, the cause is release of estrogen or testosterone into the body because of problems with the ovaries, testicles, adrenal glands or pituitary gland.
In both girls and boys, the following may lead to peripheral precocious puberty:
A tumour in the adrenal glands or in the pituitary gland that secretes estrogen or testosterone
McCune-Albright syndrome
Exposure to external sources of estrogen or testosterone, such as creams or ointments
In girls, peripheral precocious puberty may also be associated with:
Ovarian cysts
Ovarian tumours
In boys, peripheral precocious puberty may also be caused by:
A tumour in the cells that make sperm (germ cells) or in the cells that make testosterone (Leydig cells)
Gene mutation — a rare disorder called familial gonadotropin-independent sexual precocity, which is caused by a defect in a gene, can result in the early production of testosterone in boys, usually between ages 1 and 4.
Risk factors
Factors that increase a grandchild's risk of precocious puberty include:
Being a girl. Girls are much more likely to develop precocious puberty.
Being obese. If your grandchild is significantly overweight, he or she has a higher risk of developing precocious puberty.
Being exposed to sex hormones. Coming in contact with an estrogen or testosterone cream or ointment, or other substances that contain these hormones (such as an adult's medication or dietary supplements), can increase your grandchild's risk of developing precocious puberty.
.Having other medical conditions Precocious puberty may be a complication of McCune-Albright syndrome or congenital adrenal hyperplasia — conditions that involve abnormal production of the male hormones (androgens). In rare cases, precocious puberty may also be associated with hypothyroidism.
Complications
Possible complications of precocious puberty include:
.Short height Grandchildren with precocious puberty may grow quickly at first and be tall, compared with their peers. But, because their bones mature more quickly than normal, they often stop growing earlier than usual. This can cause them to be shorter than average as adults. Early treatment of precocious puberty, especially when it occurs in very young grandchildren, can help them attain more height than they would without treatment.
Polycystic ovary syndrome. Girls who begin menstruating before the age of 8 are at increased risk of developing this hormone disorder later on during puberty.
Coping and support
Grandchildren who begin puberty early may feel different from their peers, which can cause social and emotional problems such as low self-esteem, depression and substance abuse. As a parent, you also may have trouble dealing with your grandchild's early development.
If you, your grandchild or other members of your family are having difficulty coping, seek counselling. Psychological counselling can help your family better understand and handle the emotions, issues and challenges that accompany precocious puberty. If you have questions or would like guidance on how to find a qualified counsellor, talk with a member of your health care team.
Prevention
Some of the risk factors for precocious puberty, such as sex and race, can't be avoided. But, there are things you can do to reduce your grandchild's chances of developing precocious puberty, including:
Keeping your grandchild away from external sources of estrogen and testosterone — prescription medications for adults in the house or dietary supplements containing estrogen or testosterone, for example.
Encouraging your grandchild to maintain a healthy weight.
