What should I do if my child has precocious puberty?

Many people are very familiar with the term "precocious puberty". It is not particularly unfamiliar. It mainly refers to people's excessive precocious behavior. However, precocious puberty is now increasingly used to refer to physiological precocity, especially for children. The incidence of precocious puberty has been increasing due to too many hormones in food and excessive environmental pollution. Many parents are afraid that their children will suffer from precocious puberty. So what should we do about precocious puberty?

(1) Medroxyprogesterone acetate (MEP) or chlormadinone acetate: It can directly inhibit the release of GnRH, FSI and LH, so it can treat precocious puberty. The commonly used dose is 4 to 8 mg/d. Its disadvantages are that it has no effect on accelerating bone age development, long-term use can lead to atrophy of the target organs of gonadal steroids, and menstruation resumes slowly after discontinuation of the drug. Because this drug has corticosteroid-like effects, it can cause weight gain, hypertension, and Cushing's syndrome.

(2) Cyclomethicone: It is a derivative of progesterone. It can bind to androgen receptors to block the effects of testosterone and dihydrotestosterone, and it can also competitively block the pituitary GnRH receptors to inhibit the release of FSH and LH. Usage: 70-100 mg/(m2·d), orally or 100-200 mg/m2, intramuscularly, once every 2-4 weeks. It has a significant inhibitory effect on the development of sexual organs. In addition to side effects such as headache, fatigue, insomnia, and nausea, it may also have an inhibitory effect on ACTH secretion. People who use this drug for a long time should pay attention to changes in adrenal cortex function.

(3) GnRH analogue (GnRH-A): GnRH-A is currently the most effective drug for the treatment of true precocious puberty. GnRH-A is an analogue of natural GnRH with some amino acid structures changed. It retains the biological activity of GnRH, has a stronger affinity with the anterior pituitary GnRH receptor, is not easily degraded, and has a longer half-life. Therefore, its effect is stronger than GnRH. GnRH-A continuously acts on GnRH receptors, downregulating GnRH receptors, reducing the sensitivity of pituitary LH secreting cells to GnRH, blocking the negative feedback mechanism after the receptors, activating the pathway, inhibiting LH secretion, and rapidly decreasing the level of sex hormones. This effect is reversible, and the function of the hypothalamic-pituitary-gonadal axis can return to normal after discontinuation of the drug. Currently, sustained-release formulations of GnRH-A are commonly used, such as leuprorelin or triptorelin (Daptolide). The two have the same usage: 50-60 μg/kg each time, subcutaneous injection, with a larger initial dose. A booster injection is given 2 weeks later (especially for those who have their menarche), followed by once every 4 weeks, with an interval of no longer than 5 weeks. Generally, after GnRH-A injection, GnRH, testosterone, and E2 levels will temporarily increase within a few days. After one week, it gradually drops to pre-pubertal levels, until the secretion of testosterone and estrogen is completely suppressed. After 6 months of treatment, the growth rate can be reduced to 5-6 cm/year. Girls experience reduced breast size, less pubic hair, less menstruation or amenorrhea. Boys experience reduced testicles, less pubic hair, and less frequent penile erections. No obvious side effects have been found in long-term use, but it should be discontinued when puberty arrives.

In fact, precocious puberty will not only cause harm to your child's physical and mental health, but also bring unintentional pressure to the life of the entire family. Your child will also feel that he or she is out of tune with other children of the same age. Therefore, parents must prevent and treat their children's psychological problems and continue to give them warmth and encouragement, so that they can regain hope in life.