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Problems of Delayed and Precocious Puberty
The Endocrinology Division has an active program for assessment and treatment for delayed puberty. The division is also involved in a program to evaluate and treat children with early pubertal development. Normal puberty usually begins no earlier than age 8 in girls and age 9 for boys (the average age is 10.5 for girls and 12 for boys). Precocious Puberty Signs of early puberty before age 8 in girls include the development of breasts or pubic hair or the onset of menstruation. Indications for boys before age 9 are the appearance of pubic hair or enlargement of the penis or testicles. The onset of acne in both sexes can also occur. There has been discussion in the last few years that girls who are 6 to 8 and starting puberty early are not a cause for concern because they are developing slowly. Many pediatricians are not referring those girls to an endocrinologist because of the idea that they may be normal. “Physicians need to know that some 6- to 8-year-old girls with early puberty may not need treatment, but some of them will have rapidly progressive puberty and should be evaluated for treatment,” said Karen Klein, M.D., a Children’s endocrinologist who specializes in puberty problems. “If a girl shows signs of puberty early and is growing rapidly, she should be seen. Any girl younger than 6 should definitely be evaluated.” Boys who start puberty before age 9 should always be evaluated because precocious puberty is very unusual in boys and can be caused by a tumor or other pathology. Treating early puberty is important for physical as well as emotional and social reasons. Children with precocious puberty may initially appear taller than their peers, but they stop growing too soon and end up at a shorter height than normal. If untreated, boys typically grow no taller than 5 feet 4 inches and girls rarely reach 5 feet. Lupron, a depot injection given once a month, is the standard of care for both girls and boys with central precocious puberty. There is a new drug for precocious puberty being tested that would only require injections every 3 months. Delayed Puberty Girls should be referred for evaluation if they show no signs of puberty by age 13 (no breasts or pubic hair). Boys need to be evaluated by age 14 if they show no signs of puberty (no pubic hair and no increase in size of the testicles). “Most of the 14- to 15-year-olds we see are going to be normal kids, they are just delayed, but we need to do tests to determine that,” said Dr. Klein. “Growth hormone deficiency could be a cause for pubertal delay, so children who are not growing well and who also have delayed puberty should see an endocrinologist.” If the child has simple delay of puberty and no other pathology, treatment is usually reassurance and waiting. Treatment for boys can also be a very small dose of testosterone, or another anabolic steroid, for a short period of time in order to help get puberty started and help the psychosocial issues associated with the delay. For girls, estrogen preparations are sometimes, but rarely, given for a brief time. Physicians can call central scheduling at (858) 966-5999 for an appointment. If it is an urgent matter, physicians should call the Endocrinology office at (858) 966-4032 and ask to speak to one of the endocrinologists. © Children's Specialists of San Diego - Physician-to-Physician News - No.8, Fall 2004 |
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Children's Specialists Division of Endocrinology/Diabetes