Three-year-old boy with precocious puberty

If a three-year-old boy is found to be suffering from precocious puberty during a check-up, parents must not ignore it and must take it seriously. In this case, once it is confirmed, the treatment is still very complicated. It probably requires a detailed examination to be confirmed. The causes of the disease are very diverse. Some children also need to undergo bone age testing, which is also a way to determine precocious puberty.

(I) Detection of bone development indicators

1. Bone age: represents the maturity of bones and can accurately reflect the maturity of puberty. In true precocious puberty and congenital adrenal hyperplasia, bone age is often earlier than actual age. In simple premature breast development, bone age is not advanced, while in primary hypothyroidism, bone age is significantly delayed.

2. Bone mineral content and bone density: It is a quantitative indicator of bone salt deposition, which can accurately reflect the development and maturity of bones in childhood and adolescence. Bone age, bone mineral content and bone density reflect the development and maturity of bones from two different aspects, and the two complement each other. The bone mineral content and bone density of children with true precocious puberty are usually significantly higher than those of children of the same age, and the more severe the condition and the longer the course of the disease, the more obvious the increase.

(II) Pelvic B-ultrasound

In addition to determining whether there are space-occupying lesions in the ovaries, B-ultrasound should also focus on observing the development of the ovaries and uterus. The undeveloped uterus is tubular-shaped, while the uterus in late puberty is lute-shaped. B-ultrasound can also accurately measure the length, width, and thickness of the uterus and ovaries and calculate their volume. In addition, the diameter and number of follicles can be measured.

(III) Serum sex hormone measurement

The secretion of sex hormones has obvious age characteristics. Both boys' blood testosterone and girls' blood estradiol are higher before the age of 2, then decrease and remain at a low level after the age of 2, and then increase again during puberty. Their levels are closely related to the degree of development. The sex hormone levels of children with precocious puberty are significantly higher than those of normal children of the same age, and the increase in sex hormones in those with gonadal tumors is often even greater. Patients with congenital adrenal hyperplasia have elevated levels of 17α-hydroxyprogesterone in the blood and 17-ketosteroids in the urine.

(IV) Gonadotropin Determination

It is of great significance in distinguishing true from false precocious puberty. The level is elevated in true cases, low in false cases, and significantly elevated in tumors. The secretion of FSH and LH also has age differences similar to those of sex hormones. In early adolescence, their secretion is characterized by sleep-induced pulsatile release. Therefore, a single blood sample often cannot reflect the actual secretion level. It is more meaningful to collect a 24-hour urine sample for measurement.

(V) Luteinizing hormone-releasing hormone (LHRH) stimulation test

It is very valuable in distinguishing true from false precocious puberty.

(VI) Vaginal exfoliated cell smear

Continuous examination and observation can help us understand the impact of estrogen on vaginal epithelial cells and determine the level of estrogen.