What is Precocious Puberty?

Precocious puberty refers to the fact that boys show their second sexual characteristics before the age of 9 and girls reach the age of 8. According to the pathogenesis and clinical manifestations, it is divided into central (gonadotropin-releasing hormone-dependent) precocious puberty and peripheral (non-gonadotropin-releasing hormone-dependent) precocious puberty. In the past, it was called true precocious puberty and pseudoprecocious puberty. Central precocious puberty (CPP) has a hypothalamic-pituitary-gonadal axis (HPGA) process that is similar to normal adolescent development and matures until the reproductive system matures; that is, the hypothalamus is secreted and released in advance Gonadotropin-releasing hormone (GnRH), which activates the pituitary to secrete gonadotropins to develop the gonads and secrete sex hormones, thereby enabling internal and external genital development and secondary sexual characteristics. Peripheral precocious puberty is caused by the rise of steroid hormones in the body to adolescent levels caused by various reasons, so there is only the early appearance of secondary sexual characteristics, and there is no complete process of sexual development. ^[1]

Precocious puberty

1. Central sexual precocity (CPP)

Also known as true precocious puberty, due to the premature activation of hypothalamic-pituitary-gonadal axis and GnRH pulse secretion, in addition to the development of secondary sexual characteristics, the child also has the development of the ovaries or testes. The process of sexual development is consistent with the order of normal adolescent development. Just ahead of time. Mainly include the organs secondary to the central nervous system

Precocious puberty is more common in girls. Idiopathic precocious puberty is about 9 times more common in boys than boys. In boys, precocious puberty is characterized by a higher rate of development of central nervous system abnormalities (such as tumors). Sexual development is similar to the normal puberty development process, but the clinical manifestations are quite different. It can develop in all age groups before puberty, and the symptoms develop at different speeds. Some can be stopped for a period of time before sexual development. After the symptoms subsided. In the process of sexual development, both boys and girls are concerned with the rapid growth of height and weight and the acceleration of bone maturation. Due to the rapid growth of bones, the epiphysis can be merged earlier. Although the height is higher than that of children of the same age in the early stage, the height is adult It is rather short. After puberty, the children were normal except that they were shorter than the general population.

The sexual development of peripheral precocious puberty is very different from the above law. Boys with precocious puberty should pay attention to the size of the testicles. If the testicles> ml, it indicates central precocious puberty. If the testicles are not enlarged, but the virilization progresses, it suggests that the precocious puberty may be derived from the adrenal glands.

Detailed and complete medical history, including sexual development, vaginal bleeding, and whether or not to take endocrine drugs. The determination of FSH and LH in the blood by the radioimmunoassay method can help to distinguish between true and pseudoprecocious puberty. Physical precocious puberty may have enlarged ovaries and cystic changes. Adrenal cortical disorders are suspected and can be used for retroperitoneal angiography. Frontal and lateral image of the skull. Observe the size of the saddle to exclude tumors.

1. Determination of plasma FSH and LH

FSHFollicle Cytokinin, secreted by the pituitary gland, can promote follicular development.

LH-luteinizing hormone, secreted by the pituitary gland, can promote ovulation.

The basal values of plasma FSH and LH in children with idiopathic precocious puberty can be higher than normal, which is often difficult to judge. The GnRH stimulation test, also known as the luteinizing hormone releasing hormone (LHRH) stimulation test, is required. Generally, intravenous injection of Gnrh is performed at 2.5 g / kg / maximum dose 100 g). Serum LH and FSH are measured before injection (basic value) and 0, 60, 90, and 120 minutes after injection. When the HL peak is> 15U / L (female), or> 25U / L (male); when LH / FSH peak> 0.7, LH peak / base value>, it can be considered that its gonad axis function has been activated.

2. Bone age determination

Bone age was assessed according to X-rays of the hands and wrists, and whether bone development was advanced. Children with precocious puberty were generally older than their actual age.

3.B-ultrasound

Select pelvic B-ultrasound to check girl's ovarian and uterine development. Boys pay attention to testis, adrenal cortex and other parts. If pelvic B-ultrasound shows multiple follicles 4mm in ovary; precocious puberty, if a single follicle with diameter> 9mm is found , Mostly cysts, if the ovary is not large and the uterus length> 5cm and see the thickening of the endometrium is mostly exogenous androgen effect.

4.CT or MRI examination

doubt

Purpose of treatment

Inhibit or reduce chronic development, especially to prevent menstrual cramps in girls, Inhibit bone maturity, improve the final rise in adulthood, and restore the appropriate psychological behaviors at the appropriate age.

2. Etiology treatment

Patients with tumors should be surgically removed or given chemotherapy. Those with radiation therapy or hypothyroidism should be given thyroid preparations to correct thyroid function. Patients with congenital adrenal hyperplasia can be treated with cortisol hormones.

3. Drug treatment

(1) GnRHa Natural GnRH is a 10-amino acid polypeptide. Currently, several GnRHa commonly used are the 6th amino acid in the molecule, that is, glycine is replaced by D-tryptophan and D-serine. , D-histidine, D-leucine made of long-acting synthetic hormone, its role is to reduce regulation, reduce the secretion of pituitary gonadotropin, so that estrogen to return to prepubertal levels. It can be injected intramuscularly at a dose of 0.1 mg / kg every 4 weeks. After administration, the patient's sexual development and height increase, and bone age maturity can be controlled. Its role is reversible. Early treatment can improve the final height in adulthood.

(2) Gonadal hormone Its mechanism of action is to use high-dose sex hormone feedback to inhibit hypothalamic-pituitary gonadotropin secretion. For example, medroxyprogesterone, also known as progesterone, is a progesterone derivative, which is used for precocious puberty in girls, and it is maintained after a decrease in efficacy. Cyproterone is a 17-hydroxyprogesterone derivative, which not only blocks the sex hormone receptors but also reduces the release of gonadotropins. The two drugs mentioned above cannot improve adult height.

Tips: In terms of drug treatment, mild precocious puberty can be treated with traditional Chinese medicines such as Zhibai Dihuang Pill, Dayin Bu Wan and other decoctions; moderate or more precocious puberty can be treated with progesterone and gonadotropin-releasing hormone under the guidance of a doctor. Drugs.

4. Western medicine treatment of precocious puberty

At present, in terms of drug therapy, the proposed agent for gonadotropin-releasing hormone is currently the most effective drug for treating precocious puberty. This drug can down-regulate GnRh receptors on the surface of gonadotropin-releasing hormone cells and secrete its sex hormones. Reduced, biological activity is reduced, this is the most effective, but this is often used in heavier children, puberty to the fourth and fifth stages, or menstruation, these children only apply this.