Hi All!
I recently had a counseling call on this same subject. I did find the
following article, which was very helpful to the mother. Perhaps it would
help in your case as well, Suzanne.

Laura Wright,
Jackson, MS

http://health.discovery.com/diseasesandcond/encyclopedia/2727.html

>
precocious puberty>
By John Wegmann, MD, Puberty is a time when the body changes and is able to
reproduce for the first time. Precocious puberty is when these changes occur
earlier than normal. What is going on in the body? The primary sexual changes
that occur during puberty are the growth and maturation of the ovaries in
girls and the testicles in boys. The secondary changes are the development of
the breasts, sexual hair, widening of the pelvis in girls and increase in
muscle mass in boys. Puberty begins when a hormone called gonadotropin (GnRH)
is released from an area at the base of the brain. Gonadotropin is carried to
the pituitary gland. It causes the pituitary glands to release luteinizing
hormone (LH) and follicle-stimulating hormone (FSH). In females, LH and FSH
stimulate the ovaries to make the hormone, estrogen. In males, they stimulate
the testes to make the hormone, testosterone. Precocious puberty occurs when
this process begins early. This is also called central precocious puberty or
CPP. It also can occur if other stimuli trigger early sex hormone production
or release. This is called peripheral precocious puberty or PPP. With CPP,
sexual changes occur in the normal sequence seen in puberty. With PPP, this
order can be mixed up. Partial forms of precocious puberty are fairly common.
The most common forms involve premature development of the breasts in girls,
or isolated, premature development of sexual hair in girls or boys. Premature
thelarche is the early development of breast tissue without any other signs
of sexual maturity. It occurs in the first 2 years of life and lasts about 3
to 5 years. It rarely progresses any further. Menstruation occurs at the
usual age and reproductive capacity is not affected. It is usually a benign
condition but may be the first sign of true precocious puberty. Girls with
premature thelarche should be followed and evaluated if they show other signs
of sexual maturation or accelerated growth. Premature adrenarche refers to
the appearance of sexual hair prior to age 8 in girls and age 9 in boys,
without other signs of maturation. This occurs much more often in girls than
in boys. It is also more common in African American children. It is usually a
benign condition. Rarely, it can be a sign of a form of congenital adrenal
hyperplasia, or overgrowth of tissue in the adrenal gland, which may require
treatment. Girls with premature adrenarche may develop polycystic ovary
disease , which means multiple cysts develop on the ovary, as adults. Some
girls develop premature menarche. This is when menstrual periods begin
earlier than usual, without other signs of puberty. Usually these girls have
only 1 to 3 early periods. Once these periods end these girls go on to have a
normal puberty and menstrual cycles. This is less common than premature
thelarche or adrenarche. What are the signs and symptoms of the disease?
Puberty is called precocious in African American girls if they develop
breasts before they are 5 or 6 years old. It is called precocious in
Caucasian girls if they develop breasts before they are 6 or 7 years old.
African American and Caucasian boys both start puberty at about 9 years old.
Puberty is called precocious for them if they begin sexual changes before
this time. Precocious puberty is much more common in girls than it is in
boys. Children with CPP grow quicker than normal. Children with isolated,
partial forms of precocious puberty, on the other hand, usually grow
normally. In normal male puberty and in male CPP, the testicles enlarge
before the penis begins to enlarge. In PPP, the penis grows much larger than
the testicles. Mental development is usually the same as other children their
age. Mood swings are not uncommon, but serious psychological problems are
unusual. What are the causes and risks of the disease? Precocious puberty can
be caused by:
small growths in the brain
structural defects or tumor of the brain
<A HREF="http://health.discovery.com/diseasesandcond/encyclopedia/2704.html">hydrocephalus</A>, a disorder where there is an abnormal amount of spinal fluid
in the brain
severe head trauma
cranial radiation, where the brain is exposed to X-rays
certain brain infections
<A HREF="http://health.discovery.com/diseasesandcond/encyclopedia/2692.html">fetal alcohol syndrome</A>
severe <A HREF="http://health.discovery.com/diseasesandcond/encyclopedia/1845.html">epilepsy</A>, a central nervous system disorder causing seizures
tumors This disease can also be inherited. The risk in a family where one
parent carries the gene gives a 50 percent risk that male infants would be
affected. This disease also carries a 50 percent risk that female infants
would be carriers of the gene with each pregnancy. Sometimes no cause can be
found. Estrogen can cause premature sexual changes, like breast development,
that can look like precocious puberty. Estrogens are found in:
cosmetics
hair and body creams
oral contraceptives
some vitamins
certain meats, like poultry These precocious changes go away after the
estrogen exposure is stopped. What can be done to prevent the disease?
Precocious puberty cannot be prevented. How is the disease diagnosed?
Precocious puberty is first diagnosed when a doctor or parent notices
secondary sexual changes. Further testing includes:
<A HREF="http://health.discovery.com/diseasesandcond/encyclopedia/1090.html">X-rays of the bones</A>
blood tests to check hormone levels
ultrasound
<A HREF="http://health.discovery.com/diseasesandcond/encyclopedia/1175.html">CT </A>and <A HREF="http://health.discovery.com/diseasesandcond/encyclopedia/1369.html">MRI</A> scans of body tissues What are the long-term effects of the
disease? Some forms of this disease cause the skeleton to mature quickly. At
first, these children are taller than their peers. But, because the skeletal
maturation is advanced, growth stops early for these children. They end up
being very short adults. Because their growth and sexual development is
advanced, some children with precocious puberty may feel isolated from their
peer group until the maturation of the peer group catches up with them.
Parents and teachers need to have age-appropriate rather than
appearance-appropriate expectations of these children in terms of their
behavior. What are the treatments for the disease? Children with CPP whose
bone age is 2 years more advanced than their chronological age can be treated
with long-acting GnRH agonists, such as histrelin. These are given by
injection every 3 to 4 weeks. These injections cause sexual development to
stop and normal growth rate to return. Girls can be given this treatment
until they are between 11 and 12 years old. Boys can be given this treatment
until they are between 12 and 13 years old. Children who have precocious
puberty for reasons other than CPP need to have the primary disorder treated.
This can include:
removal of a tumor
cortisol treatment of congenital adrenal hyperplasia, which is overgrowth of
the adrenal gland tissue, or thyroid hormone replacement for those with
hypothyroidism
specialized medicines to treat McCune-Albright syndrome, which is a disorder
caused by ovarian cysts in children. This results in brown spots on the skin
along with precocious puberty Children with premature thelarche or adrenarche
need to be followed by a doctor, but do not need treatment. What are the side
effects of the treatments? Some girls with CPP will have vaginal bleeding
about 2 weeks after the first injection of a GnRH agonist. This usually does
not occur after this. How is the disease monitored? Children with this
disease should be monitored by a pediatric endocrinologist.



"The art of being wise is the art of knowing what to overlook."

- William James, American psychologist and philosopher

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