Precocious Puberty and Normal Variant Puberty: Definition, etiology, diagnosis and current management - Review

Abstract

This review describes several aspects of the management of precocious puberty (PP) and variants in girls and boys.PP is characterized by early pubertal changes, acceleration of growth velocity and rapid bone maturation that often result in reduced adult height. Onset of pubertal signs before the age of 8 years in girls and 9 years in boys should always be evaluated carefully. The main principles of therapy are to stop the progression of secondary sex characteristics and menses (in girls), to increase final adult height, to promote psychosocial well-being, and to treat the underlying cause if known.Conflict of interest:None declared.

Central precocious puberty: revisiting the diagnosis and therapeutic management

“…However, clinical manifestations below the age of 4 years suggest organic etiologies, particularly hypothalamic hamartomas. Information about family history, including the age at pubertal onset and similar cases in the family, may be useful in the diagnosis of familial CPP (10,(16)(17)(18)(19).…”

“…The physical examination must also investigate the presence of neurofibromas and café-au-lait spots with regular edges, which are suggestive of type 1 neurofibromatosis and related to CPP (associated with optic glioma). Café-au-lait spots with irregular and often jagged edges may indicate the diagnosis of McCune-Albright syndrome, which is associated with peripheral precocious puberty of ovarian etiology (10,(16)(17)(18)(19).…”

“…In 40% of the boys, transient pubertal gynecomastia may occur. In both genders, development of pubic hair is associated with adrenarche (10,(16)(17)(18)(19). The stage of female and male pubertal development is determined by Marshall and Tanner's classification (20,21).…”

“…A progression from one stage to another in less than six months and a height velocity above 6 cm/year characterize a progressive condition. Height, weight, and height velocity should be plotted in reference curves, and height is generally found to be above the familial pattern (10,(16)(17)(18)(19).…”

Puberdade precoce: condições associadas

“…Sem o diagnóstico e tratamento precoces, crianças em PPC estão em grave risco de iniciação sexual mais cedo, abusos sexuais, avanço da idade óssea acelerada e baixa estatura com obesidade na vida adulta (11) , o que resulta em elevado risco de desenvolvimento de hiperinsulinemia (12) , diabetes mellitus e doenças cardiovasculares (13) . Sendo uma condição com repercussões a curto, médio e longo prazo no estado de saúde da criança, torna-se de fundamental importância o planejamento e a implementação de ações de promoção à saúde voltadas para as crianças com PPC (14) . Para isso, faz-se necessário conhecer quem são essas crianças, sendo esse conhecimento o alvo da presente inquietação, que objetiva analisar as características das crianças com PPC, identificando-se tanto suas características clínico-epidemiológicas como os fatores determinantes para o recebimento de uma atenção oportuna à saúde.…”