Premature sexual development of children
True premature puberty
Premature puberty is consideredTrue when it is associated with an excessively high level of two hormones produced by the pituitary: follicle stimulating (FSH) and luteinizing hormone (LH), called gonadotropins. These hormones stimulate the sexual glands (testes and ovaries). FSH and LH are important for normal sexual development. If they are produced in excess, sexual maturation may occur prematurely and proceed more quickly. True premature puberty, especially in young men, can also be associated with structural changes in the brain, for example, due to congenital disorders such as hydrocephalus (hydrocephalus), and also with a decreased thyroid function.
Prejudicial premature puberty
About pseudoprepresentation of pubertySay when it is not associated with an excess of FSH and LH, but there are conditions that lead to an increase in the level of circulating sex hormones (testosterone in boys and estrogens in girls). False premature puberty is less common than true, and its causes can be tumors of the ovaries, testes and adrenals, as well as oral steroids. In order to overcome the difficulties associated with changes in the psychological state and behavior due to premature puberty, the teenager and his family need psychological counseling and support. These changes give more concern for premature puberty than for normal. The awareness of younger children is less than that of older children, it is ready to overcome the problems associated with physical maturity and the impact of hormones.
• Individual counseling is often useful for young children who have problems with early puberty.
Errors in diagnostics
An erroneous diagnosis of premature puberty can be made in the following cases:
- Premature development of mammary glands
In some girls, mammary glands canIncrease in size at the age of six months to two years. The process can be unilateral or bilateral. In this case, no pubic hair and growth jump are observed. This condition is not a sign of the disease and does not require treatment.
- Hasty diagnosis of premature puberty
Girls under the age of eight and boys youngerFor nine years, pubic hair growth may occur in the absence of other secondary sexual characteristics. Most often this phenomenon is observed in children in the countries of Asia, Africa and the Caribbean. Such a state can be associated with a temporary acceleration of growth rates. Treatment is usually not required, however, if such phenomena are seen in a child under six, this can be a cause for concern. Premature puberty in boys is much less common than in girls, and is often associated with a serious disease, such as a brain tumor. If the boy has signs of premature puberty, especially accompanied by a bilateral increase in the testicles, the cause is usually an increased level of pituitary hormones (FSH and LH) in the blood. However, if during puberty a teenager has a one-sided enlargement of the testicle, one can suspect his tumor. If the boy has all the external manifestations of puberty, but he has small (prepubertal) testicles that develop slower than other parts of the body, this can mean that the cause of premature puberty is hyperfunction.
Management of patients
The first step in the treatment of patients with prematurePuberty is the identification of its cause. At the initial stage, it is necessary to exclude the brain tumor. When the cause is identified, measures are planned for its effective elimination.
Maturity of the skeleton
Sexual maturation, both normal andPrematurely, accompanied by the development of the skeleton. After the jump in growth in the pubertal period, the long tubular bones of the limbs stop growing. Premature puberty is associated with short stature, as the growth of bones in these children slows down, and then ceases at an earlier age than in healthy ones. Small growth can have a strong psychological impact on the child, therefore, in premature puberty, an important part of the treatment is slowing the rate of formation of the bone system. The cause of premature puberty in girls is rare. Most often there is an early manifestation of signs of normal puberty. In this case, puberty will proceed in the same way as if it began at an age appropriate to the norm. This type of premature puberty can be both hereditary and a single case when a similar history was not observed in the family history.
Suspect a girl for any diseaseIt is necessary in the event that puberty occurs not according to the standard scheme; For example, when simultaneously with the growth of the mammary glands on the pubis, only individual hairs appear or the development of secondary sexual characters occurs faster than normal. One such disease is Albright-McCun's disease, which is characterized by damage to the skin, bone and endocrine glands, as well as premature menstruation. Also, the presence of any latent disease should be suspected if there are signs of brain damage.
With premature puberty in girlsTo estimate or appreciate probability of presence of the latent disease it is possible by means of ultrasonic research of bodies of a small basin. In this case, the uterus and the ovaries are mainly examined. If early puberty is a variant of the norm, and not a consequence of the disease, ultrasound examination will confirm the expected changes in internal organs that occur during normal puberty. In particular, ultrasound will show an increase in the uterus and multiple cysts in the ovaries. The absence of these characteristics should alert the pediatrician. However, in most cases, there are no abnormalities - and there is no need for further examination.