Precocious Puberty
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
Menstruation before the age of 10 years or the development of secondary sexual characteristics before the age of 8 years.
Many cases are idiopathic (constitutional). Other causes: hormone secreting tumors, cerebral tumors (craniopharyngioma or any other), McClune-Albright syndrome, previous head injury or meningitis, encephalitis, & accidental ingestion of hormone preparations. Damage to inhibitory brain pathways causes precocity, damage to stimulatory pathways, amenorrhoea &, in a child, delayed puberty.
Diagnosis
- History includes details of the pubertal development & neurodevelopmental milestones, & past medical history
- Examination should look for causes as above & any abdominal masses
- Basic blood hormone profile
- Abdominal ultrasound scan
- Skull x-ray (Craniopharyngioma in skull base may calcify)
Management
- All patients must be referred to a specialist gynae endocrine clinic
- Treatment is directed at the cause, if one is found
- GnRH analogues may be required
- Careful counseling is very important including parents
- Contraception should be discussed/issues of sexual abuse too