Your Health

Precocious Sexual Development

Back to Previous Page

(Precocious Puberty; Premature Puberty)

Definition

Girls enter puberty between the ages of 8-14. Boys enter this stage between the ages of 9-14. Sometimes the physical changes may happen earlier. This is called precocious sexual development or premature puberty.
For girls, this means that before the age of eight they may:
  • Develop breasts
  • Have armpit or pubic hair
  • Have mature sex organs
  • Experience their first period
For boys, this means before the age of nine they may have:
  • Enlarged sex organs
  • Armpit, pubic, or facial hair

Causes

In about 25%-75% of affected boys, this condition is due to an underlying medical conditions. However, for many girls and some boys there is no known cause.
Some known causes of premature sexual development include:
Pituitary Gland
Pituitary
Copyright © Nucleus Medical Media, Inc.
Causes specific to girls:
  • Having ovarian tumor or cysts
  • Taking estrogen
Causes specific to boys:
  • Having tumors on the testicles
  • Taking male sex hormones (androgens)
Other causes:

Risk Factors

Factors that increase the risk of precocious puberty include:
  • Sex: girls are 2 to 5 times more likely to experience premature puberty than boys
  • Family history—some cases may run in families
  • Taking sex hormones
  • Head injury
  • Radiation of head
  • Infection in brain
  • Some studies have suggested a link between obesity and premature puberty

Symptoms

One symptom common to both boys and girls is a premature growth spurt in height. Children with this condition may be taller than their peers. As an adult, they may be shorter. The rapid growth also makes their bones stop growing sooner than normal. Other symptoms include:
  • In girls, early arrival of:
    • Breast development
    • Pubic hair
    • Armpit hair
    • Onset of period
    • Ovary enlargement
    • Cysts on ovaries
  • In boys, early arrival of:
    • Facial hair
    • Armpit hair
    • Pubic hair
    • Penis growth
    • Increased masculinity
    • Testicle enlargement
  • In both girls and boys, early arrival of:
    • Body odor
    • Acne
    • Behavior changes
    • Growth spurt

Diagnosis

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. An assessment of puberty milestones and growth will be done. An x-ray of the left wrist bone may also be taken. This will help to assess if the bone growth is normal for your child’s age.
Depending on these results, other tests may be ordered, including:
  • Adrenal and pelvic ultrasound —images of kidneys and sexual organs created by sound waves
  • Testicular ultrasound if testicular enlargement is uneven
  • MRI of the brain—detailed images of the brain
  • Blood tests to measure the levels of hormones such as:
    • In girls: follicle-stimulating hormone (FSH), luteinizing hormone (LH)
    • In boys: testosterone
    • Human chorionic gonadotropin (hCG) levels—hormone that affects growth
    • Thyroid hormone levels—if hypothyroidism suspected
    • Growth hormone-releasing hormone (GHRH) stimulation test
    • Dehydroepiandrosterone (DHEA) levels—early form of sex hormones

Treatment

The treatment depends upon the cause.
If the bone age is about the same as the child's actual age and there is no known cause, there is no treatment. The child will continue to be monitored. Psychological support may be recommended if a child is struggling.
Other children may require treatment. This may include medication or surgery.

Medications

Medication is often used in children whose bone age is older than their actual age. These medications stop or slow sexual development. They also halt the rapid bone growth and encourage normal growth.
These medications called hormone suppressors may include:
  • Leuprolide acetate
  • Histrelin
  • Nafarelin
Metformin has also been shown to be effective in delaying puberty.

Psychological Support

Developing before their peers may cause social challenges in some children. Psychological support may be helpful. Talk to your child's doctor about what options are available.

Surgery

Surgery may be needed if the early puberty is caused by a tumor or other lesions. The procedure will depend on the location and size of the tumor.

Ongoing Monitoring

The doctor will continue to check your child’s height, weight, and sexual development. This will help to note any changes or show if the treatment has been effective.

Prevention

Most precocious development cannot be prevented. To help reduce the chance, make sure your child is kept as healthy as possible. This includes making sure they are eating well and getting all the nutrients they need. Help your child maintain a healthy weight. Avoid exposure to sex hormones.

RESOURCES

The American Academy of Family Physicians http://www.familydoctor.org/

American Academy of Pediatrics http://www.healthychildren.org/

CANADIAN RESOURCES

Caring for Kids http://www.caringforkids.cps.ca/

Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/

References

Blondell RD, Foster MB, Kamlesh CD. Disorders of puberty. American Family Physician website. Available at: http://www.aafp.org/afp/990700ap/209.html . Accessed August 15, 2012.

Cesario SK, Hughes LA. Precocious puberty: a comprehensive review of literature. J Ob Gyn Neonatal Nurs. 2007;36:263-274

DynaMed Editorial Team. Precocious puberty. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated March 15, 2012. Accessed August 15, 2012.

Himes JH, Obarzanek E, Baranowski T, et al. Early sexual maturation, body composition, and obesity in African-American girls. Obesity Research . 2004;12:64S-72S.

Ibanez L, Valls C, Ong K, et al. Metformin therapy during puberty delays menarche, prolongs pubertal growth, and augments adult height: a randomized study in low birth weight girls with early-normal onset of puberty. J Clin Endocrinol Metab . 2006;91:2068-2073.

Papathanasiou A, Hadjiathanasiou C. Precocious puberty. Ped Endocr Rev . 2006;3:182-187.

Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics . 2002;110:903-910.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Copyright © EBSCO Publishing
All rights reserved.