Precocious Puberty Causes

Aka: Precocious Puberty Causes

advertisement

II. Causes: Central (GnRH dependent, complete Isosexual)

  1. Idiopathic
  2. CNS Lesion (e.g. pituitary tumor, hypothalamic hamartoma)
  3. Severe Head Trauma
  4. Cranial irradiation
  5. Perinatal conditions
  6. Meningoencephalitis history
  7. Secondary to GnRH independent Precocious Puberty
  8. Hypothyroidism
  9. Chronic Adrenal Insufficiency

III. Causes: Peripheral (GnRH independent - always abnormal)

  1. Adrenal Causes
    1. Adrenal causes result in rapidly progressive Adrenarche and Virilization
      1. Girls: contrasexual (e.g. clitoromegaly)
      2. Boys: Isosexual (e.g. penile enlargement)
      3. Other findings
        1. Growth acceleration
        2. Severe acne
        3. Hirsutism
        4. Pubic and axillary Hair Growth
        5. Voice change
    2. Causes
      1. Congenital Adrenal Hyperplasia
        1. 21-OH deficiency (21 Hydroxlase deficiency, most common)
        2. 11-OH deficiency (11 Hydroxylase Deficiency)
      2. Adrenal Tumor: contrasexual or Isosexual)
        1. Functioning adenoma or carcinoma results in Glucocorticoid excess or Virilization
      3. Cushing Syndrome
        1. Glucocorticoid excess
  2. Gonadal Causes in Females
    1. McCune-Albright Syndrome (Isosexual)
      1. Autonomously functioning Ovarian Cysts release Estradiol
      2. Findings
        1. Polyostotic fibrous dysplasiaof bones
        2. Cafe Au Lait spots
        3. Precocious Puberty
        4. Vaginal Bleeding (may be only sign)
        5. Associated with Hyperthyroidism, Cushing's Syndrome
    2. Functional Ovarian Cysts (releasing Estradiol)
      1. Abdominal Pain
      2. Thelarche
      3. Vaginal Bleeding
    3. Granulosa cell tumor
      1. Abdominal Pain
      2. Estradiol or Testosterone excess
  3. Gonadal Causes in Males
    1. Familial Male (Testotoxicosis, Isosexual)
      1. Luteinizing hromone receptor activating mutation
      2. Results in premature Testosterone secretion
      3. Presents with testicular enlargement and Virilization onset in age <4 years
    2. HCG-Secreting tumor (high HCG levels, tumor may be ectopic from Testes)
      1. Mild testicular enlargement
      2. Virilization
    3. Leydig Cell Tumor
      1. Asymmetric testicular enlargement
      2. Virilization
  4. Miscellaneous Cause
    1. Hypothyroidism
    2. Exogenous Hormone exposure (e.g. Testosterone gel, Estrogen Creams)
    3. Endocrine disrupting chemical exposures (e.g. Pesticides, BPA, phthalates, flame retardants)

IV. Causes: Benign Early Puberty

  1. Constitutional or Idiopathic Precocious Puberty
    1. Bone Age is GREATER than Chronological Age
    2. Lab markers (if checked) are all consistent with early Puberty
    3. Contrast with all other benign causes in which Bone Age is CONSISTENT with Chronological Age
  2. Girls
    1. Fatty Breast tissue (Lipomastia)
    2. Benign Premature Thelarche
      1. Isolated Breast development with glandular tissue development
    3. Benign premature Menarche
      1. Prepubertal Vaginal Bleeding
      2. DDx includes Hypothyroidism, McCune-Albright Syndrome, genital Trauma, mass, infection or foreign body
    4. Benign Premature Adrenarche
      1. Isolated pubic hair (and may include axillary hair) develops under age 6 years
      2. Distinguish from Congenital Adrenal Hyperplasia, Cortisol excess, adrenal tumor (see step 2c)
  3. Boys
    1. Benign Gynecomastia of Adolescence
    2. Familial Gynecomastia
      1. DDx includes Testicular Cancer, Adrenal Adenoma, performance enhancing drugs, Hypogonadism
  4. Infants
    1. Isolated Pubic Hair in Infancy
      1. Isolated pubic hair of infancy typically resolves by age 6-24 months
      2. Consider exogenous exposure to Hormones and endocrine disruptors (e.g. Pesticides)
    2. Minipuberty of infancy
      1. Transient activation of hypothalamic-pituitary axis after birth until 6 months in boys, 2-4 years in girls
      2. Transient sex Hormone rise causes acne, Penile GrowthBreast development, Vaginal Bleeding

V. Causes: Contrasexual Development Causes

  1. Boys
    1. Estrogen-Secreting adrenal tumor
  2. Girls
    1. Excessive pubic hair
      1. Adrenal hyperplasia
      2. Benign Premature Adrenarche
      3. Polycystic Ovary Disease (older girls)
    2. Virilization (clitoromegaly and increased Muscle)
      1. Ovarian tumor
      2. Adrenal tumor
      3. Cushing's Syndrome
      4. Hyperprolactinemia
      5. Acromegaly
      6. Exogenous androgens

VI. References

  1. Blondell (1999) Am Fam Physician 60:209-24 [PubMed]
  2. Brown (2025) Am Fam Physician 112(5): 513-21 [PubMed]
  3. Klein (2017) Am Fam Physician 96(9): 590-99 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Precocious Puberty Causes." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Topics in Sexual Development

advertisement