Many dwarf patients flock to the hospital during the winter holidays, but among the children who come to the hospital. However, some of the children who come to the hospital are not treated until their parents think about it after they are 15 years old. As a result, some children are too old for treatment and the results are not very satisfactory. He told reporters that there are more than 8 million children with dwarfism in China, and the prevalence of dwarfism in Shanghai is 3.77% and 5% in Beijing. In view of this situation, Prof. Gao reminded parents that when they find that their children are stunted or shorter than their peers, they should seek medical attention in time to avoid delaying the disease. Summit of Endocrinology Department of Wuhan Union Medical College Hospital
There are many reasons for short stature, among which precocious puberty or late puberty is one of them. So, what is precocious puberty or late puberty? What are the effects on the body? How can they be treated? With parents’ questions, the reporter interviewed Professor Gao Gao from the Department of Endocrinology of Wuhan Union Medical College Hospital, who has been engaged in endocrine research for more than 20 years and has rich clinical experience in children’s growth and development.
(A) Definition of precocious and late sexual maturity
Before the age of 8 years for girls and 9 years for boys, secondary sexual characteristics appear, i.e., girls show breast development, pubic hair, nipple pigmentation, irregular vaginal bleeding, and the first menstruation. In boys, testicular enlargement, penis enlargement, pubic hair, axillary hair, acne, thickening of voice, and seminal emission.
Late sexual maturity is the opposite of precocious sexual maturity, which refers to delayed or staggered development. In severe cases, they are unable to have children for life due to immature development. Generally speaking, if a person reaches the age of 14 and still lacks any signs of developing sexual characteristics, he or she should consider the possibility of late sexual maturity. It usually takes 4.5 years from the onset of secondary sexual characteristics to the onset of adult characteristics in a normal person. If it takes more than 5 years from the appearance of pubertal somatic developmental characteristics to the perfect growth of reproductive organs, it should also be considered if there is late sexual maturity.
(2) Causes of precocious puberty and late puberty
Precocious puberty can be divided into three categories according to its etiology: (1) Central precocious puberty or true precocious puberty, which is caused by early activation of hypothalamic-pituitary-gonadal axis. (2) Peripheral precocious puberty or pseudoprecocious puberty, which is caused by sex hormone production from tumors or tissue hyperplasia (congenital adrenocortical hyperplasia, adrenocortical tumors, gonadal tumors) or ingestion of exogenous sex hormones (large or long-term use of drugs or foods containing sex hormones or use of skin care products containing sex hormones). Pseudo-precocious puberty mostly has other symptoms in addition to the performance of sexual characteristics.
The causes of late sexual maturity are mostly related to genetic genetic diseases and chromosomal disorders, such as Turner’s syndrome (female phenotype, amenorrhea, backward height and weight, low posterior hairline, and no development of sexual characteristics), which is a chromosomal disorder. In addition, systemic immune diseases and malnutrition, such as tuberculosis, diabetes mellitus, malabsorption syndrome, etc., can also delay puberty.
(C) Hazards of precocious puberty and late puberty
Due to early puberty and early secretion of sex hormones, children with precocious puberty may temporarily accelerate their growth and become taller than their peers, but due to the stimulation of sex hormones, the bone age significantly exceeds the actual age, causing the epiphysis to close early and shortening the growth time, and eventually leading to short stature. In addition to affecting the lifelong height of the affected children, precocious puberty also causes the early appearance of sexual development, resulting in the occurrence of juvenile sex crimes among boys, and girls who have premature menstruation are often very nervous, which affects their normal life and study. Therefore, parents, schools and even the whole society should pay attention to the problem of early sexual maturity of children.
Children with late sexual maturity are prone to low self-esteem and psychological disorders because of the late appearance or non-appearance of secondary sexual characteristics, and some patients end up with short stature.
(D) Treatment of precocious puberty and late puberty
The main objectives of treatment for precocious puberty are: (1) to improve the final adult height of the child. (2) To control and slow down the maturity and speed of secondary sexual characteristics of the child. (3) To prevent early onset of menarche. (4) To restore the child’s psychological behavior at the actual age of life. Regarding the treatment of central precocious puberty, gonadotropin-releasing hormone analogues (GnRHa) have been widely used in recent years and have achieved good results. However, after the application of GnRHa, the growth rate of some children decreased and their lifetime height did not improve significantly. Therefore, some scholars proposed the application of recombinant human growth hormone (rhGH) to improve the lifetime height of children with central precocious puberty. Many clinical studies have shown that the combination of growth hormone can significantly improve the growth rate of children without accelerating the maturation of bone age compared with GnRHa treatment alone, thus achieving the goal of improving adult height. Regarding the treatment of peripheral precocious puberty, it is important to target the cause. For example, congenital adrenocortical hyperplasia should be treated with adrenocorticotropic hormone replacement therapy; for precocious puberty caused by tumors, tumors should be surgically removed as early as possible; for precocious puberty caused by exogenous sex hormones, the intake of sex hormones should be stopped.
Late precocious puberty should also attract parents’ attention, and its treatment should be aimed at treating the original disease, improving its final height and sex characteristics development in adulthood, and ensuring the psychological health of the affected children. For example, Turner’s syndrome should be treated with recombinant human growth hormone as early as possible, which can lead to significant height growth. When his bone age reaches 12 years old or above, he can start to give oral low-dose estrogen treatment to promote breast and external genital development.
Professor Gao pointed out that in addition to the above treatment measures, children should also be encouraged to participate in outdoor sports, especially jump rope, basketball, swimming and other lower limb sports, which can stimulate bone growth and help children grow, and at home, you can often touch the door frame jump. Secondly, cultivate good eating habits, not picky, not partial food, in addition to sufficient fish, meat, eggs and milk, but also intake of a variety of vitamins. Adequate sleep is also very important. Usually children are tight on homework and sleep less; when they are on vacation, they can sleep to their heart’s content. But Professor Gao also reminded that some children play too late at night, late at night, the next day to noon still can not get up, this violation of the biological clock of sleep is not quality, not beneficial to the growth of height.