central precocious puberty 2

Central Precocious Puberty (CPP) Description

Central precocious puberty (CPP) is a condition that affects children, causing them to enter puberty at an abnormally early age. In girls, CPP typically begins before the age of 8, while in boys, it starts before the age of 9 [2][5]. This condition is characterized by the same biochemical and physical features as normally timed puberty but occurs at an earlier age.

Signs and Symptoms

The signs and symptoms of central precocious puberty are similar to those experienced during normal puberty. They include:

• Breast bud development in girls
• Enlarging testicles and penis in boys
• Pubic and underarm hair growth
• Facial hair growth
• Spontaneous erections and/or ejaculations in boys
• Development of acne
• Deepening of the voice

These symptoms can be a sign that puberty has started too early, and it's essential to consult with a healthcare professional for proper evaluation and diagnosis [3][4].

References

[2] 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.

[3] Precocious puberty has different causes depending on the type. Central precocious puberty occurs when your child’s brain releases androgens too early. In most cases, the cause of this — especially in girls and children AFAB — is unknown.

[4] A sudden growth spurt, with breast bud development, pubic and underarm hair, and body odor can be signs of central precocious puberty.

[5] Central precocious puberty (CPP) is when the normal process of puberty starts too early. · Peripheral precocious puberty (PPP).

Signs and Symptoms of Central Precocious Puberty

Central precocious puberty (CPP) is a condition that causes early sexual development in girls and boys. The signs and symptoms of CPP are the same as normal puberty, but they occur at an abnormally early age.

• Acne: One of the common signs of CPP is acne, which can appear on the face, chest, or back.
• Body odor: As with normal puberty, body odor can become more pronounced in children with CPP.
• Growth spurt: A rapid growth spurt, often accompanied by an increase in height and weight, is a common sign of CPP.
• Pubic and axillary hair development: The appearance of pubic and axillary (underarm) hair is another sign of CPP.
• Voice deepening: In boys, the voice may begin to deepen as puberty progresses.

These signs and symptoms can vary in severity and timing, but they are generally the same as those experienced during normal puberty. However, the key difference is that they occur at an abnormally early age, typically before 8-9 years old for girls and 9-14 years old for boys.

References:

• [2] Central precocious puberty is a condition that causes early sexual development in girls and boys.
• [6] pubic, underarm, or facial hair development
• [7] 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.
• [9] Precocious Puberty Symptoms. The signs of early puberty and puberty are usually the same. It's the timing that's different. Signs include:
• [10] The other signs and symptoms include increased linear growth, acne, muscular changes, body odor, and pubic and axillary hair development.

Diagnostic Tests for Central Precocious Puberty (CPP)

Central precocious puberty (CPP) can be diagnosed using various tests that measure the levels of hormones and growth factors in the body. The goal of these tests is to confirm the activation of the hypothalamic-pituitary-gonadal axis, which is responsible for regulating puberty.

• GnRH Stimulation Test: This test involves administering a synthetic gonadotropin-releasing hormone (GnRH) to stimulate the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Blood samples are taken before and after the injection to measure the levels of these hormones. A positive response indicates activation of the HPG axis, confirming CPP.
• Measurement of Morning LH Levels: This is a simple blood test that measures the level of LH in the morning. Elevated levels (> 0.2 to 0.3 mIU/L) are indicative of CPP.
• Ultrasound and MRI Scans: These imaging tests can help identify any underlying causes of CPP, such as tumors or abnormalities in the brain or pituitary gland.

Interpretation of Test Results

The results of these diagnostic tests are used to confirm the diagnosis of CPP. A positive response to the GnRH stimulation test or elevated morning LH levels are indicative of CPP. Imaging tests may reveal underlying causes of CPP, such as tumors or abnormalities in the brain or pituitary gland.

References:

• [2] A test called a gonadotropin-releasing hormone (GnRH) stimulation test helps identify the type of precocious puberty.
• [5] Measurement of morning LH levels is the best initial biochemical test for the diagnosis of GnRH-dependent precocious puberty, with values > 0.2 to 0.3 mIU/L (> 0.2 to 0.3 units/L) ...
• [7] The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for confirming the activation of the hypothalamic–pituitary–gonadal axis in ...
• [9] The gonadotropin-releasing hormone (GnRH) stimulation test is the gold standard for confirming the activation of the hypothalamic–pituitary–gonadal axis in ...
• [11] The central origin of precocious puberty is confirmed by stimulation testing resulting in pubertal gonadotropin concentrations as an indication of HPG axis activation.

Treatment Options for Central Precocious Puberty

Central precocious puberty (CPP) can be treated using various medications that help delay the onset of puberty. The primary goal of treatment is to increase adult height and postpone development of secondary sexual characteristics.

• Gonadotropin-Releasing Hormone (GnRH) Analogues: These are the most commonly used medications for treating CPP. GnRH analogues work by suppressing the production of sex hormones, thereby delaying puberty. They can be administered via injection or implant.
  • Long-acting GnRH analogues have been shown to be effective in treating CPP and have an enviable track record of safety and efficacy [2].
  • GnRHas are a safe and effective treatment for CPP that can be administered by intramuscular injection, subcutaneous injection, and subcutaneous implant [14].
• Histrelin Implant: This is another treatment option for CPP. It involves minor surgery to place an implant under the skin of the upper arm, which lasts up to a year.
  • After the treatment stops, puberty starts again [9].

Other Considerations

The decision to treat CPP depends on various factors, including the age of the child and the progression of puberty.

• Rapidly progressing symptoms: If the child has rapidly progressing symptoms or if bone age is significantly advanced, consider treatment [10].
• Final height and reproductive function: Long-term outcome studies have shown that GnRH analogue treatment can lead to normal final height, body proportions, body composition, bone mineral density, and reproductive function [11].

References

[2] 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 ... (Search Result 1)

[14] Gonadotropin-releasing hormone analogues (GnRHas) are a safe and effective treatment for CPP that can be administered by intramuscular injection, subcutaneous injection, and subcutaneous implant. (Search Result 14)

Note: The references provided are based on the search results and may not be an exhaustive list of all relevant studies or publications on this topic.

Central precocious puberty (CPP) can be challenging to diagnose, and it's essential to consider differential diagnoses to rule out other conditions that may present similarly. Here are some possible differential diagnoses for CPP:

• Premature thelarche: This is a condition where breast development occurs before the age of 8 in girls, but it's not accompanied by other signs of puberty such as pubic hair or vaginal bleeding [6].
• Premature adrenarche: This refers to the early onset of adrenal androgen secretion, leading to changes in body odor, acne, and pubic hair growth before the age of 8 in girls [6].
• Congenital adrenal hyperplasia (CAH): This is a group of inherited disorders that affect the adrenal glands, leading to an overproduction of androgens. CAH can cause early puberty-like symptoms in girls, including breast development and pubic hair growth [9].
• Idiopathic central precocious puberty: In many cases, the exact cause of CPP remains unknown, and it's classified as idiopathic [13][14].

It's crucial to note that these differential diagnoses require a thorough medical evaluation, including laboratory tests and imaging studies, to rule out other conditions. A correct diagnosis of CPP can only be made after excluding these possibilities.

References:

[6] - This condition is characterized by breast development in girls younger than 8 years, but it's not accompanied by other signs of puberty. [9] - Congenital adrenal hyperplasia (CAH) can cause early puberty-like symptoms in girls, including breast development and pubic hair growth. [13][14] - In many cases, the exact cause of CPP remains unknown, and it's classified as idiopathic.