Early puberty may need treatment

By BRUCE A. EPSTEIN

© St. Petersburg Times, published January 11, 2001

There is a wide range of ages at which young children undergo the physical changes that accompany puberty.

In most cases, it is safe to predict that girls will begin to develop breasts and then pubic hair between the ages of 8 and 13. Menstrual periods typically start at 12 to 13 years of age. Boys normally develop testicular enlargement and then pubic hair between the ages of 9 and 14.

Puberty is said to be precocious (very early) if it begins before age 6 or 7 in girls and age 9 1/2 in boys. Precocious puberty is five to seven times more likely in girls than boys and occurs in one out of every 5,000 to 10,000 American children.

The changes of puberty are triggered by the pituitary gland, a pea-sized structure at the base of the brain and under the influence of the hypothalamus gland. Before puberty begins, higher brain functions prevent the hypothalamus from allowing the pituitary gland to begin secreting hormones. Precocious puberty most likely results when this "restraint" is removed ahead of schedule, allowing the pituitary gland to begin secreting gonadotropins, which in turn stimulate the ovaries or testes to produce sex hormones.

These sex hormones (especially estrogen in girls and testosterone in boys) are what normally cause sexual maturity to begin. The hormonal changes of precocious puberty are normal, but the whole process begins a few years too soon.

Signs that a child may have precocious puberty are the development of secondary sex characteristics: breasts, pubic hair and menstruation in girls, and pubic hair, an enlarged penis and testicles, facial hair and vocal deepening in boys.

In addition, children undergoing precocious puberty enter a period of rapid growth and weight gain similar to that of normal adolescence, when the bones harden and mature.

In most cases, no reason can be found to explain why the pituitary gland signaled the ovaries and testicles to prematurely make female or male hormones. Sometimes, precocious puberty is caused by an abnormality in the ovaries, testicles or adrenal glands, and, rarely, it is due to a hormone-secreting tumor in the pituitary or hypothalamus. Therefore, any girl who shows signs of sexual maturation before age 6 or 7, and any boy who begins to mature before age 9 1/2, should definitely see a doctor.

Often the child with precocious puberty is referred to a pediatric endocrinologist, a specialist who treats children with hormone and growth problems. Blood and urine tests are performed to uncover the presence of elevated sex hormone levels. X-rays, particularly of the wrist and hand, can show whether the bones are growing too fast. Tests to determine whether the problem involves the pituitary, hypothalamus or both may be necessary. Imaging tests (CT or MRI scans) might also be performed to detect tumors in the pituitary, hypothalamus, liver, ovary or testes.

Children with very early puberty tend to be tall for their age when they start growing, but they stop growing earlier than other young people and may be quite short as adults.

In addition, children with precocious puberty look different from their peers, causing them to be self-conscious and embarrassed about their bodies. Adults often expect them to act more maturely simply because they look so much older. As a result, many of these children -- especially boys -- are much more aggressive than others their own age, leading to behavior problems.

Normal early puberty does not have to be treated. True precocious puberty may need treatment. What course it takes depends on the cause. It may involve surgery and radiation if the cause is a hormone-secreting tumor. New medication can reverse some of the signs of precocious puberty.

Parents should call their child's doctor if there are any signs of early sexual development or if the pre-adolescent seems to be growing and gaining weight too quickly.

-- Bruce A. Epstein practiced pediatrics in St. Petersburg for 26 years. He edits the Web site http://www.kidsgrowth.com.

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