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Precocious puberty (Aetiology (Endocrine Primary hypothyroidism,…
Precocious puberty
Aetiology
Endocrine
Primary hypothyroidism
Idiopathic
Unknown cause
Congenital
Hypo/pit: cerebral palsy
Ovary: late onset CAH, McCune-Albright synd
Neoplastic
Hypo/pit: CNS lesion
Ovary: ovarian cyst (hormone secreting)
Pathophysiology
Central precocious (GnH-dependent)
Prematurely high LH levels causing ovarian
stimulation and puberty
Idiopathic, congenital, CNS lesion
Peripheral precocious (GnH-independent)
Problem is ovarian/other extra-hypothalamis/pitutuary
Primary hypothyroidism, ovarian cysts (sec hormone),
McCune-Albright syndrome, late onset CAH
Puberty
Pulsatile increase in LH
Development of 2 sex characteristics (breast budding, accelerated growth, pubic/axillary hair, menarche)
Average age 12-13y
Diagnosis
Examination
Tanner staging
Breast budding, height,
hair growth (pubic, axilla)
Neurological
Signs UMN lesion
Investigations
Bloods
FBC, U+E, LFTs, TFTs
Hormones: GnRH, FSH/LH, oestrogen, progesterone,
17-hydroxyprogesterone, corticosteroids, aldosterone
Imaging
Abdo/pelvic USS: ovarian cysts
CT/MRI head: CNS lesion
X-ray wrist: bone age
Bedside
Height, weight, BMI
History
DH
Current meds, allergies
FH
Precocious puberty
PMH
Cerebral palsy, CAH,
McCune-Albright, hypothyroidism
SH
Smoking, alcohol, home life
PC/HPC
Puberty, menarche, CNS symptoms,
thyroid symptoms, abdo pain
Clinical
presentation
Early puberty (<8y)
Early menarche (<10y)
Management
Medical
GnRH analogues
Indication: idiopathic chronic pelvic pain
Route: injectable
MOA: breast, uterine and ovarian regression,
no impact on BMD, allow final height
Conservative
Information, advice, support
Identify and treat underlying cause
Definition
Early onset and progression of
puberty in a female <8y or menarche <10y;
onset of puberty in a male <9y
Complications
Restricted final height
Accelerated early linear growth
and early epiphyseal closure