Early Puberty

• Puberty is the development of secondary sexual characteristics to attain reproductive capacity.
• Early puberty is when a child's body begins puberty too early.  This is when puberty begins before age 8 in girls, and before age 9 in boys.

• Normal puberty for girls: breast growth, acceleration of height velocity, pubic/axillary hair growth and then menarche (onset of menstrual periods).
• Breast growth tends to begin at 11 years old.
• Menarche tends to begin around 13 years old, and is unusual to see before pubic hair stage 4.

• Male puberty is: testicular growth, growth of the penis, pubic/axillary hair growth, acceleration in height velocity and voice deepening with facial hair growth.

• The onset of puberty is caused by secretion of GnRH by the hypothalamus.  This causes an increase in LH and FSH.
• Increased LH levels stimulate the production of sex steroids by testicular cells or ovarian cells.
• Increased FSH levels cause enlargement of gonads in both sexes.  They promote follicular maturation in girls and spermatogenesis in boys.
• Early puberty can be true precocious or pseudo-precocious
• True Precocious - pubertal development caused by early activation of the hypothalamic-gonadal axis.  This can be caused by tumours in the hypothalamic-pituitary region, meningitis, cerebral palsy and hydrocephalus.
• Pseudo-Precocious - pubertal development caused by sex steroids secreted without activation of the hypothalamic-gonadal axis.  This can be caused by adrenal sex steroids as a result of an adrenal tumour, Cushing's Syndrome and congenital adrenal hyperplasia., or by gonad steroids as a result of an ovarian tumour/cyst and toxicosis.

• Need to Liaise with School - primary school-aged girls may need to use teachers toilets to dispose of sanitary products.  The child may also need to keep sanitary products or spare underwear at school in case of an accident.  Children may also recurrently miss lessons for appointments.
• Injections - will have to regularly go to the clinic to get injections.
• Regular Pubertal Staging - This may be embarrassing for the child.
• Body Image - The child may realise that they look different from their peers, which could cause body image issues.

GnRH Antagonists

• Reduces the release of FSH and LH, stopping puberty.  
• Act via desensitization and down-regulation of pituitary GnRH receptors.
• Nasal inhaler taken daily
• IM injection taken monthly
• SC injection taken 3 monthly
• Implant changed yearly