Diagnostic points of precocious puberty
1, girls <8 years old breast development, pubic hair presentation to the onset of menarche; boys <9 years old testicular enlargement (length diameter >2cm), penis growth thickening, pubic hair, voice change, spermatorrhea, etc..
2. Accelerated growth of height and weight. May be accompanied by primary disease manifestations of precocious puberty.
3. In cases of exogenous estrogen intake (such as birth control pills), there is darkening of the areola and labia, vaginal “withdrawal” bleeding for about 1 month, followed by breast receding to undeveloped state in 1 to 2 months. Hu Min, Department of Pediatrics, Maternal and Child Health Hospital, Jiaxing Medical College
4. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2 ) values were significantly elevated.
Ultrasonography showed enlarged ovaries with volume >1 ml and testicular volume >2.5 ml. X-ray showed early bone age. Skull X-ray, CT or MRI to exclude central organic pathology.
Plasma FSH, LH measurement
FSH – folliculopoietin, secreted by the pituitary gland, promotes follicular development.
LH, luteinizing hormone, is secreted by the pituitary gland and promotes ovulation.
The basal values of plasma FSH and LH in children with idiopathic precocious puberty can be higher than normal, which is often not easy to determine, so the GnRH stimulation test, also known as luteinizing hormone releasing hormone (LHRH) stimulation test, is needed. Generally use intravenous injection of Gnrh, according to 2.5μg/kg/maximum dose ≤ 100μg), before injection (basal value) and 30, 60, 90 and 120 minutes after injection were taken to determine serum LH and FSH, when HL peak > 15U/L (female), or > 25U/L (male); LH/FSH peak > 0.6, LH peak/basal value > 3, can be considered that their gonadal axis function has been initiated.
Bone age determination
Bone age is assessed based on hand and wrist x-rays to evaluate whether skeletal development is overdeveloped, and children with precocious puberty generally have bone age that exceeds the actual age.
Ultrasound examination
If the pelvic ultrasound shows multiple follicles ≥4mm in the ovaries, it is precocious puberty. If a single follicle >9mm in diameter is found, it is more likely to be a cyst. If the ovaries are not large but the uterus is >3.5cm in length and endometrial thickening is seen, it is more likely to be exogenous androgen action.
CT or MRI examination
CT or MRI of the head or abdomen should be performed if intracranial tumor or adrenal gland disease is suspected to be the cause.
Other examinations
Other tests can be further selected according to the clinical manifestations of the child, such as T3, T4, TSH for suspected hypothyroidism, increased testosterone and estradiol concentrations in gonadal tumors, blood 17-hydroxyprogesterone (17-OHP) and urinary 17-ketone in children with congenital adrenocortical hyperplasia steroids (17-KS) were significantly increased.
Treatment options for precocious puberty
The treatment of this disease depends on the etiology. The treatment of central precocious puberty aims at: inhibiting or slowing down sexual development, especially preventing the onset of menstruation in girls, inhibiting skeletal maturation, improving the eventual elevation in adulthood, and restoring the appropriate psychological behavior at the appropriate age.
(I) Etiological treatment
Tumors should be removed surgically or treated with chemotherapy, radiotherapy, thyroid preparations to correct thyroid function in cases caused by hypothyroidism, and cortisol hormone therapy in patients with congenital adrenal cortical hyperplasia.
(B) Drug therapy
1.Gonadotropin-releasing hormone analogues (GnRHa)
The natural GnRH is a 10 amino acid peptide, and the several GnRHa currently in use are long-acting synthetic hormones made by replacing the 6th amino acid in the molecule, namely glycine, with D-tryptophan, D-serine, D-histidine and D-leucine, whose The effect is to reduce the secretion of pituitary gonadotropins and restore estrogen to prepubertal levels through down regulation. It can be injected intramuscularly once every 4 weeks (i.e. 28 days) at the rate of 0.1mg/kg. After the drug is administered, the patient’s sexual development and height growth, and bone age maturation are controlled, and its effect is reversible.
2.Gonadotropin
The mechanism of action is to inhibit hypothalamic-pituitary gonadotropin secretion by using high-dose sex hormone feedback. For example, methandrostenolone, also known as Angioprogesterone, is a progesterone derivative used for precocious puberty in girls, with a daily oral dose of 10~30mg, which is reduced and maintained after the emergence of therapeutic effect. Cyproterone is a 17-hydroxyprogesterone derivative, which can not only block sex hormone receptors, but also reduce the release of gonadotropins at a dose of 70-150mg/m2 per day. The above two drugs cannot improve height in adulthood.
Tip: In terms of medication, mild precocious puberty can be treated with traditional Chinese medicine such as Zhi Bai Di Huang Wan, Da Yin Tonic Wan and other tonics; moderate or above and true precocious puberty can be treated with progesterone and gonadotropin-releasing hormone drugs under the guidance of doctors.
Precocious puberty prevention
1, to prevent precocious puberty, parents should also pay attention to give children less chicken, beef, mutton, pupae, etc., and do not abuse the so-called children’s food without strict testing.
2, do not give children indiscriminate nutritional supplements, such as royal jelly, pollen preparations, chicken embryo and other “tonic”, proper storage of contraceptive drugs, breast enlargement beauty products, etc., so that children do not accidentally take or contact.
3, early detection, timely treatment. In addition to the necessary medical knowledge, parents should pay more attention to observe whether the child has premature appearance of secondary sexual characteristics, children under 10 years old suddenly accelerated height growth and other phenomena, once the discovery of abnormalities, should be promptly to the regular hospital for medical treatment.
4. Children with precocious puberty should be educated about menstruation and menstrual hygiene, and sex education should be started early according to children’s comprehension.
In conclusion, if children have precocious puberty, as parents must release their worries, analyze the cause, explain patiently, do not let the child have a mental burden, and at the same time actively cooperate with the doctor, careful examination and treatment, then, children with precocious puberty can still develop normally, and will not affect future marriage and childbirth.