Diagnostic criteria
I. Boys before the age of 10 and girls before the age of 8 who have developed secondary sexual characteristics.
II. Clinical manifestations.
(A) True precocious puberty.
1. Idiopathic precocious puberty: early gonadal activity due to premature excitation of pituitary gonadotropic function. Girls can ovulate and become pregnant, boys can ovulate sperm, growth is accelerated, but eventually there is still a lack of height, early fusion of bone age, and the same mental state as children of the same age.
2.Intracranial tumor: It is more common in boys. In addition to central nervous system symptoms, there are also hypothalamic symptoms such as polydipsia, polyuria, polyphagia and obesity, which are seen in hypothalamic glioma, craniopharyngioma, pineal tumor, etc.
3.Multiple bone fiber developmental abnormalities (McCune-Albright Syndrome): all girls. In addition to the early appearance of sexual characteristics, with bilateral or unilateral bone fiber dysplasia, ipsilateral limb skin with brown pigmentation called “coffee milk spot”, the number of more than 5 or diameter > 0.5cm can also be preceded by limited tract bleeding.
4, hypothyroidism: some children in the treatment of girls breast development, boys testicular enlargement, but because of the low secretion of thyroid hormone growth retardation, mental retardation, bone age backward.
5. Other tumors: such as choriocapillary epithelial carcinoma, hepatoblastoma, etc. can cause increased secretion of sex hormones.
(B) Pseudogonadism: premature development of secondary sexual characteristics caused by peripheral glands, premature secretion of pituitary GnRH and immature gonads, no ovulation and sperm discharge.
1. Gonadal tumors: testicular mesenchymal cell tumor in men and ovarian granulosa cell tumor in women.
2, congenital adrenal cortical hyperplasia, cholesterol metabolism, congenital defects in various enzymes, homosexual precocious puberty in men and heterosexual precocious puberty in women.
3, tumors of the adrenal cortex.
4, medical source, taking sex hormone drugs, androgen increase in women can cause clitoral hypertrophy, hairy, muscular development. The increase of estrogen in males can cause breast development, areola enlargement and deepening of color, and the misuse of contraceptives and hormone-containing supplements can cause breast enlargement and even vaginal bleeding in girls.
(C) some precocious puberty.
1, premature breast development: girls are more common, breast enlargement, areola deepening.
2.Simple pubic hair appearance: premature secretion of androgens by the adrenal cortex or premature sensitivity of pubic hair and axillary hair receptors to androgens is related.
3.Simple early menarche: girls present with transient ovarian function activity and vaginal bleeding.
III. Laboratory tests.
(A) Measurement of sex hormones.
1, Blood five sex hormone levels.
2. Urinary 17-ketosteroid, 17-hydroxysteroid levels.
(II) Determination of liver function.
(C) thyroid function measurement.
(iv)Adrenal function measurement.
(iv) Fundus examination.
(V) Ultrasound of the abdomen, whether there are tumors in the girl’s uterus and ovaries.
(vi) Vaginal smear examination for girls.
If necessary, abdominal and cranial CT examinations should be done to exclude brain tumors and tumors in other areas.
Treatment principles
I. Treatment for the cause of the disease.
(a) Stop taking tonic drugs, do not eat hormone-containing poultry and meat, etc., and prohibit cosmetics.
(b) Organic encephalopathy, surgery to remove the tumor.
(C) adrenal gland disease, cholesterol metabolism process caused by enzyme defects in the treatment of the cause.
II. Drug treatment
(i) Mestinone 2-10mg/d orally in 2 doses, or 100mg intramuscularly once every two weeks to inhibit gonadotropin secretion.
(ii) Chlormadinone, 2-4mg daily, can reduce androgen secretion and stop the development of skeletal maturation.
(iii) Luteinizing hormone-releasing hormone analog (LH~RHa) therapy. The duration of drug therapy varies from patient to patient, and should be terminated when the desired height of the child and parents has been achieved or the epiphysis has closed.