Makindo Medical Notes.com |
|
---|---|
Download all this content in the Apps now Android App and Apple iPhone/Pad App | |
MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd |
Cause | Clinical Features | Investigations | Management |
---|---|---|---|
Central (True) Precocious Puberty (e.g., Idiopathic, CNS Tumours) |
Early development of secondary sexual characteristics, growth acceleration, advanced bone age, headaches or visual disturbances if CNS tumour is present. | Serum LH and FSH (elevated), MRI of the brain (to rule out CNS tumours), bone age assessment, pelvic ultrasound (in girls). | GnRH analog therapy to delay further pubertal progression, monitoring growth and development, surgical resection if a CNS tumour is present. |
Peripheral (Precocious Pseudopuberty) (e.g., McCune-Albright Syndrome, Adrenal Tumours) |
Asymmetric development of secondary sexual characteristics, café-au-lait spots (in McCune-Albright), virilization in girls, advanced bone age. | Serum estradiol/testosterone (elevated), adrenal imaging (CT or MRI), bone age assessment, genetic testing for McCune-Albright syndrome. | Treatment of the underlying cause (e.g., surgical removal of adrenal tumours), anti-estrogen or anti-androgen therapy, management of associated symptoms. |
Congenital Adrenal Hyperplasia (CAH) | Early development of pubic/axillary hair, rapid growth, virilization in girls, salt-wasting crisis in severe cases, advanced bone age. | Serum 17-hydroxyprogesterone (elevated), serum electrolytes, genetic testing for CYP21A2 mutation, adrenal ultrasound. | Glucocorticoid replacement therapy, mineralocorticoid replacement if salt-wasting form, monitoring of growth and development, surgical management of genital ambiguity if needed. |
Gonadal Tumours | Asymmetric breast development, rapid growth, early pubic hair, abdominal mass if gonadal tumour is present, virilization in girls or feminization in boys. | Serum estradiol/testosterone (elevated), ultrasound or MRI of the pelvis, serum tumour markers (e.g., AFP, hCG), bone age assessment. | Surgical resection of the tumour, chaemotherapy or radiotherapy if indicated, monitoring for recurrence, hormone therapy if necessary. |
Exogenous Hormone Exposure | Early development of secondary sexual characteristics without other signs of puberty progression, exposure history to external hormones (e.g., creams, medications). | Serum estradiol/testosterone (elevated), review of medication history, assessment for possible sources of hormone exposure. | Discontinuation of exogenous hormone sources, education on avoiding exposure, monitoring for regression of pubertal signs. |
Primary Hypothyroidism | Delayed growth, precocious puberty, delayed bone age, goiter, symptoms of hypothyroidism (fatigue, constipation, weight gain). | Serum TSH (elevated), free T4 (low), bone age assessment, thyroid ultrasound if goiter is present. | Thyroid hormone replacement therapy (levothyroxine), monitoring for resolution of precocious puberty signs and normalization of growth. |
Familial (Constitutional) | Early but normal progression of puberty, family history of early puberty, normal growth velocity and bone age. | Growth charts, family history assessment, bone age assessment, serum LH and FSH (normal). | Reassurance and monitoring, no specific treatment needed, regular follow-up to ensure normal pubertal progression. |