Introduction to the manifestations of precocious puberty in children

Here are some signs of precocious puberty in children. With the development of science and technology and the abuse of various hormone drugs, more and more children are showing signs of precocious puberty. Precocious puberty is a common developmental abnormality of the pediatric endocrine system. It refers to an abnormal disease in which girls show secondary sexual characteristics before the age of 8 and boys before the age of 9. The following is a detailed introduction to the manifestations of precocious puberty in children.

Symptoms in women include breast development, enlargement of the labia minora, estrogen-dependent changes in vaginal mucosal cells, enlargement of the uterus and ovaries, appearance of pubic hair, and menarche. In men, symptoms include enlarged testicles and penis, appearance of pubic hair, muscular development, and a deepening voice. Both men and women experience accelerated growth and bone maturation, which may ultimately lead to a lifetime height below the target height. When accompanied by central nervous system diseases such as intracranial tumors, there may be headache, vomiting, vision changes or other neurological symptoms and signs.

The first thing to do is to determine whether it is GnRH-dependent precocious puberty.

1. Secondary sexual characteristics appear early

Girls before 8 years old, boys before 9 years old.

2. Serum gonadotropin levels increase to puberty levels.

(1) Basal gonadotropin value: If the secondary sexual characteristics have reached the level of mid-puberty, the basal serum luteinizing hormone (LH) value can be used as an initial screening test. If it is >5.0 IU/L, it can be determined that the gonadal axis has been activated and there is no need for a gonadotropin-releasing hormone (GnRH) stimulation test.

(2) GnRH stimulation test This test is an important diagnostic tool for those whose gonad axis function has been activated but whose basal gonadotropin value has not increased. GnRH can increase the secretion and release of gonadotropin, and its stimulation peak value can be used as a basis for diagnosis.

The cut-off value of the LH stimulation peak for diagnosing CPP: LH peak > 5.0 IU/L, LH peak/FSH peak > 0.6 can diagnose CPP; if LH peak/FSH peak > 0.3 but < 0.6, close clinical follow-up should be combined, and the test should be repeated if necessary to avoid missed diagnosis.

3. Enlarged gonads

In girls, B-ultrasound examination shows that the ovarian volume is >1ml, and multiple follicles with a diameter of >4mm can be seen; in boys, the testicular volume is ≥4ml, and it increases progressively with the course of the disease.

4. Linear growth of height accelerates.

5. Bone age exceeds chronological age by 1 year or more.

6. Serum sex hormone levels increase to adolescent levels.

Among the above diagnostic bases, 1, 2, and 3 are the most important and necessary. However, if the course of the disease is very short when the doctor is consulted, the GnRH stimulation value may overlap with the pre-pubertal value and fail to reach the above diagnostic cut-off value; the same is true for ovarian size. Such children should be followed up for the progression of secondary sexual characteristics and accelerated linear growth, and the above tests should be repeated if necessary. The linear growth acceleration during puberty in female children usually occurs 6 to 12 months after the onset of breast development and lasts for 1 to 2 years; however, it may occur later, with about 5% of children showing it 1 year before menarche or in the year of menarche. In boys, accelerated growth occurs when the testicular volume is 8 to 10 ml or one year before voice change, and lasts longer than in girls. Advanced bone age only means that the sex hormone level has been increased for some time, and it is not a specific indicator for diagnosing CPP. Children with a short course of illness and slow development may not have obviously advanced bone age, and peripheral precocious puberty may also have advanced bone age. Elevated sex hormone levels cannot distinguish between central and peripheral precocious puberty. In summary, the diagnosis of CPP is comprehensive. The core issue is that it must meet the criteria of GnRH dependence. Clinical follow-up of progressive sexual characteristics development is of great significance.

Attention should be paid to collecting medical history related to the cause of CPP, such as infection, central nervous system lesions and other related symptoms; tumors should be excluded for all children diagnosed with CPP, and MRI examination of the sellar region of the skull is required. MRI has better resolution than CT for organic lesions of the hypothalamus and pituitary.

The above are the manifestations of precocious puberty in children that I introduced to you. Pay attention to children's physical condition and enable them to develop healthily. This is the responsibility of the family and the whole society. Any factor related to the healthy physical and mental development of children cannot be ignored. I hope that the manifestations of precocious puberty in children that I introduced to you can be helpful to you.