Precocious puberty Dr Mahtab Ordooei Precocious puberty Defined
Precocious puberty Dr. Mahtab Ordooei
Precocious puberty Defined as the onset of secondary sexual characteristics before 8 yr age in girls and 9 yr in boys.
Classification of precocious puberty FTrue precocious puberty ( central or gonadotropindependent = CPP) FPrecocious pseudopuberty ( peripheral, gonadoptropin independent (PPP) FMixed type
Conditions causing central precocious puberty • Idiopathic • organic brain lesions (inflamation, malformation, trauma, chemotherapy, radiotherapy, brain tumor) • Hypothyroidism
Conditions causing precocious pseudopuberty in females • Iso sexual ( feminizing ) conditions Mc cune – Albrightsyndrome Autonomous ovarian cyst Ovarian tumors Feminizing adrenocortical tumor Exogenous estrogens cont
• Hetrosexual (masculinizing) Congenital adrenal hyperplasia Adrenal tumor Ovarian tumor Glucocorticoid receptor defect Exogenous androgens.
Conditions causing precocious pseudopuberty in males • Isosexual congenital adrenal hyperplasia Adrenocortical tumor Leydig cell tumor Familial male precocious puberty HCG secreting tumor Teratoma cont
Glucocorticoid receptor defect Exogenous androgen • Hertrosexual Feminizing adrenocortical tumor Exogenous estrogens
Approach to patient with precocious puberty • History (Medication ) (family history of precocious puberty) • Physical examination (Wt, Ht, Eye, Thyroid, abdomen, tests) • paraclinical findings • bone age cont
• • • Estradial Testosterone LH FSH Gn. RH stimulation test (LH/FSH> 1) (LH>5 - 10 IU/L) • Sonography (ovaries, Uterus, adrenal glands, testes) • MRI of brain (MRI of hypothalamus and hypophysis) cont
The goals of treatment for CPP 1. Improvement of adult height 2. Prevention of social and psychological problems.
Treatment of CPP Gn. RH analogues Gn. RH antagonist Aromatize inhibitors
Indications for therapy with Gn. RH agonist • True precocious puberty in males • Rapid progressive CPP in girls • To stop puberty because of social and psychological reasons
The effect of Gn. RH agonist therapy on: • • Growth Skeletal age Pubertal development Hormones
Treatment is effective if: 1. Serum sex hormone concentration decrease to prepubertal levels ( testosterone < 20 ng/ d. L in boys estradial < 10 pg/m. L in girls) 1. Serum FSH and LH < 1 IU/L 2. LH/FSH < 1
Physiological status after completion of therapy • • • Growth rate Bone density Pubertal development Hormones Fertility
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