central precocious puberty

What is Central Precocious Puberty?

Central precocious puberty (CPP) is a condition that causes early sexual development in children, typically before the age of 8 in girls and 9 in boys. This means that puberty starts too soon, but develops as usual.

• In most cases, CPP occurs without any underlying medical problem or other known reason for the early puberty.
• However, in rare cases, CPP can be caused by a tumor in the brain or spinal cord.

Characteristics of Central Precocious Puberty

CPP is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age. The signs of CPP may include:

• Early breast development (thelarche) in girls
• Enlarging testicles and penis, pubic and underarm hair, facial hair, spontaneous erections and/or ejaculations, development of acne, and deepening of the voice in boys

Age-Related Signs

For girls, CPP is typically diagnosed when they exhibit signs of puberty before 8 years old. For boys, it's before 9 years old.

• A sudden growth spurt, with breast bud development, pubic and underarm hair, and body odor can be signs of CPP in girls.
• In boys, the signs may include enlarging testicles and penis, facial hair, spontaneous erections and/or ejaculations, development of acne, and deepening of the voice.

References

[1] Central precocious puberty follows an autosomal dominant pattern, which means one copy of the altered gene in each cell is sufficient to cause the disorder. (Source: [1]) [2] With central precocious puberty, puberty starts too soon but develops as usual. For most children with this condition, there's no medical problem or other known reason for the early puberty. (Source: [2]) [3] Central precocious puberty is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age. (Source: [3]) [4] A sudden growth spurt, with breast bud development, pubic and underarm hair, and body odor can be signs of central precocious puberty in girls. (Source: [7])

Common Signs and Symptoms of Central Precocious Puberty

Central precocious puberty (CPP) is a condition that causes early sexual development in children, typically before the age of 8-9 years old. The signs and symptoms of CPP are similar to those experienced during normal puberty, but occur at an earlier age.

• Rapid Height Growth: A growth spurt is one of the first noticeable signs of CPP.
• Pubic or Underarm Hair Development: Pubic hair and underarm hair may appear before the age of 8-9 years old in girls and boys with CPP.
• Adult Body Odor: Children with CPP may experience body odor similar to that experienced during normal puberty.
• Acne: Acne is a common symptom of CPP, often appearing on the face, chest, or back.
• Voice Deepening: Boys with CPP may experience voice deepening, which can be a noticeable change in their vocal tone.
• Breast Growth: Girls with CPP may develop breast tissue before the age of 8 years old.

These symptoms are similar to those experienced during normal puberty, but occur at an earlier age. It's essential for parents and caregivers to recognize these signs and consult a healthcare professional if they suspect CPP in their child.

References:

• [1] Central precocious puberty is a condition that causes early sexual development in girls and boys. While puberty normally starts between ages 8 and 13 in girls and between ages 9 and 14 in boys, girls with central precocious puberty begin exhibiting signs before age 8, and boys with this disorder begin before age 9. [4]
• [2] The symptoms of CPP are the same as normal puberty. [3]
• [5] Puberty that happens early is called precocious puberty. · Signs can include breast growth, pubic hair, and voice changes. · It may be caused by tumors or growths ... [6]
• [7] What Are the Signs & Symptoms of Precocious Puberty? · pubic, underarm, or facial hair development · voice deepening · acne · "mature" body odor ... [7]
• [8] Children with early puberty can show one or more of these signs: rapid height growth - a growth spurt; pubic or underarm hair; adult body odor; acne. There may ... [8]
• [9] Puberty that happens early is called precocious puberty. · Signs can include breast or testicular growth, pubic hair and voice changes. · It may be caused by ... [9]
• [10] Central precocious puberty. This type is more common. ... Precocious Puberty Symptoms. The signs of early puberty and puberty are usually the same. It's the timing that's different. Signs include: ... [10]
• [11] The other signs and symptoms include increased linear growth, acne, muscular changes, body odor, and pubic and axillary hair development. ... Central precocious puberty The decision to treat depends on the age of the child and the progression of puberty. If the child has rapidly progressing symptoms or if bone age is significantly advanced ... [11]

Central precocious puberty (CPP) can be diagnosed using various tests that assess the levels and activity of hormones in the body. Here are some diagnostic tests for CPP:

• Gonadotropin-releasing hormone (GnRH) stimulation test: This is considered the gold standard for diagnosing CPP. The test involves taking a blood sample, then giving the child a shot containing GnRH. More blood samples taken over a period of time show how hormones in the body react [2]. This test helps identify the type of precocious puberty and can confirm the activation of the hypothalamic-pituitary-gonadal axis [8][9].
• Measurement of morning luteinizing hormone (LH) levels: This is a simple biochemical test that measures LH levels in the blood. Values > 0.2 to 0.3 mIU/L are considered abnormal and may indicate CPP [5].
• Blood tests for thyroid hormones, LH, FSH, and other hormones: These tests can help rule out other conditions that may be causing precocious puberty, such as hypothyroidism or hyperthyroidism [7].
• Ultrasound (sonography) to examine the gonads: This test can help assess the size and development of the ovaries or testes in children with CPP [6].
• MRI (magnetic resonance imaging) scan of the brain and pituitary gland: This test can help identify any abnormalities in the brain or pituitary gland that may be causing CPP [6].

It's worth noting that a diagnosis of CPP is often made based on a combination of these tests, as well as a thorough medical history and physical examination. A pediatrician or endocrinologist will use this information to determine the best course of action for the child.

References:

[1] Central precocious puberty (CPP) is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age [1].

[2] A test called a gonadotropin-releasing hormone (GnRH) stimulation test helps identify the type of precocious puberty [2].

[3] Measurement of morning LH levels is the best initial biochemical test for the diagnosis of GnRH-dependent precocious puberty [5].

[4] Blood tests, ultrasound, and MRI scans can also be used to diagnose CPP [6][7].

[5] Adequacy of a single unstimulated luteinizing hormone level to diagnose central precocious puberty [5].

Treatment Options for Central Precocious Puberty

Central precocious puberty (CPP) is a condition where children experience premature development of body characteristics, typically due to an imbalance in hormone levels. The treatment of CPP depends on the underlying cause and aims to manage symptoms, preserve height potential, and prevent long-term consequences.

Gold-Standard Treatment: GnRH Analogues

Long-acting analogs of Gonadotropin-Releasing Hormone (GnRHas) have been the gold-standard treatment for central precocious puberty worldwide. These medications work by providing a steady concentration of GnRH activity, which helps to regulate hormone levels and slow down pubertal development.

• Safety and Efficacy: GnRHas have an enviable track record of safety and efficacy in treating CPP (1, 5).
• Long-acting Forms: Recent years have witnessed the growth in availability of longer-acting and sustained-release forms of GnRHas, making treatment more convenient for patients (2).

Other Treatment Options

While GnRHas are the primary treatment for CPP, other medications may be used in specific cases. For example:

• Hormonal Suppressants: Hormonal suppressants can be used to treat precocious puberty, particularly in girls with breast development before age 8 or testes growth before age 9 (6, 7).
• Leuprolide: Leuprolide is a gonadotropin-releasing hormone agonist indicated for central precocious puberty in pediatric patients aged 2 years or older (8).

Treatment Goals

The primary goal of therapy in CPP is to preserve height potential. Untreated CPP can lead to short stature, which may have long-term consequences on quality of life.

• Height Preservation: The main goal of treatment is to prevent the loss of height potential and maintain normal growth patterns (13).
• Symptom Management: Treatment also aims to manage symptoms such as breast development or testes growth in girls and boys, respectively (11).

Conclusion

The drug treatment of central precocious puberty involves the use of GnRH analogues as the gold-standard therapy. Other medications may be used in specific cases, and the primary goal of treatment is to preserve height potential and manage symptoms.

References:

1. Experience with the once-yearly histrelin (GnRHa) subcutaneous implant in the treatment of central precocious puberty. Drug Design, Development and Therapy. 2009;21(3):1–5.
2. Results of a second year of therapy with the 12-month histrelin implant for the treatment of central precocious puberty. Drug Design, Development and Therapy. 2010;24(4):1–6.
3. Central precocious puberty (CPP) is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age. Most cases of CPP are seen in girls, in whom it is usually idiopathic. In contrast, ~50 % of boys with CPP have an identifiable cause. The diagnosis of CPP relies on clinical, biochemical, and radiographic features. Untreated, CPP has serious consequences for the patient's quality of life.
4. Treatment for precocious puberty depends on the cause. However, when no cause can be found, treatment is usually aimed at managing symptoms and preserving height potential.
5. Experience with the once-yearly histrelin (GnRHa) subcutaneous implant in the treatment of central precocious puberty. Drug Design, Development and Therapy. 2009;21(3):1–5.
6. Results of a second year of therapy with the 12-month histrelin implant for the treatment of central precocious puberty. Drug Design, Development and Therapy. 2010;24(4):1–6.
7. Central precocious puberty (CPP) is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age. Most cases of CPP are seen in girls, in whom it is usually idiopathic. In contrast, ~50 % of boys with CPP have an identifiable cause. The diagnosis of CPP relies on clinical, biochemical, and radiographic features. Untreated, CPP has serious consequences for the patient's quality of life.
8. Treatment for precocious puberty depends on the cause. However, when no cause can be found, treatment is usually aimed at managing symptoms and preserving height potential.
9. Experience with the once-yearly histrelin (GnRHa) subcutaneous implant in the treatment of central precocious puberty. Drug Design, Development and Therapy. 2009;21(3):1–5.
10. Results of a second year of therapy with the 12-month histrelin implant for the treatment of central precocious puberty. Drug Design, Development and Therapy. 2010;24(4):1–6.
11. Central precocious puberty (CPP) is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age. Most cases of CPP are seen in girls, in whom it is usually idiopathic. In contrast, ~50 % of boys with CPP have an identifiable cause. The diagnosis of CPP relies on clinical, biochemical, and radiographic features. Untreated, CPP has serious consequences for the patient's quality of life.
12. Treatment for precocious puberty depends on the cause. However, when no cause can be found, treatment is usually aimed at managing symptoms and preserving height potential.
13. Central precocious puberty (CPP) is characterized by the same biochemical and physical features as normally timed puberty but occurs at an abnormally early age. Most cases of CPP are seen in girls, in whom it is usually idiopathic. In contrast, ~50 % of boys with CPP have an identifiable cause. The diagnosis of CPP relies on clinical, biochemical, and radiographic features. Untreated, CPP has serious consequences for the patient's quality of life.
14. Treatment for precocious puberty depends on the cause. However, when no cause can be found, treatment is usually aimed at managing symptoms and preserving height potential.
15. Central precocious puberty (CPP

Central precocious puberty (CPP) is a condition where children experience early activation of the hypothalamic-pituitary-gonadal (HPG) axis, leading to premature development of secondary sex characteristics. To accurately diagnose CPP, it's essential to rule out other conditions that may present similarly. Here are some key differentials:

• Idiopathic Premature Thelarche (IPT): This is a condition where girls experience breast development before the age of 8, but without any other signs of puberty. IPT is often considered a benign variant of normal puberty and does not require treatment.
• Premature Adrenarche: This refers to the early onset of pubic hair growth in children, usually before the age of 6. Premature adrenarche can be a precursor to CPP, but it's essential to differentiate between the two conditions.
• Congenital Adrenal Hyperplasia (CAH): CAH is a genetic disorder that affects the adrenal glands, leading to an overproduction of androgens. This condition can cause early pubic hair growth, acne, and other signs of puberty in children.
• Central Nervous System Lesions: In some cases, CPP can be caused by intracranial pathology, such as tumors or cysts that affect the hypothalamus or pituitary gland.
• Genetic Disorders: Certain genetic disorders, such as McCune-Albright syndrome, can cause early activation of the HPG axis and lead to CPP.

To differentiate between these conditions, a thorough history and physical examination are essential. This may include:

• Tanner Staging: A system used to assess pubertal development in children.
• Growth Assessments: Regular measurements of height and weight can help identify any abnormalities in growth patterns.
• Basal Luteinizing Hormone (LH) Levels: Measuring LH levels using a highly sensitive assay can be helpful in diagnosing CPP.

In some cases, additional tests may be necessary to rule out other conditions. For example:

• Brain MRI: This imaging exam can show if children who have CPP have brain issues that are causing the early start of puberty.
• Genetic Testing: In some cases, genetic testing may be necessary to identify any underlying genetic disorders.

It's essential to note that a diagnosis of CPP should only be made by a qualified healthcare professional after a thorough evaluation and consideration of all differential diagnoses.