Early pubic hair, breast, or genital development may result from normal but early maturation or from several abnormal conditions. Early puberty which is normal in every way except age is termed idiopathic central precocious puberty. It may be partial or transient. Central puberty can also occur prematurely if the inhibitory system of the brain is damaged, or a hypothalamic hematoma produces pulsatile gonadotropin-releasing hormone (GnRH). Secondary sexual development induced by sex steroids from other abnormal sources (gonadal or adrenal tumors, congenital adrenal hyperplasia, etc.) is referred to as peripheral precocious puberty or precocious pseudopuberty.

Clinical significance

Early sexual development deserves evaluation because it may :

induce early bone maturation and reduce eventual adult height,
cause significant social problems, or
indicate the presence of a tumor or other serious problem.

Measures

No single age limit reliably separates normal from abnormal processes, but the following age thresholds for evaluation will minimize the risk of missing a significant problem:

Pubic hair or genital enlargement in boys with onset before 9 years.
Breast development in boys before appearance of pubic hair and testicular enlargement.
Pubic hair before 8 or breast development in girls with onset before 7 years.
Vaginal bleeding in girls before 10 years.

Suggested causes: Environmental estrogens, sedentary lifestyle, and obesity

Other notes

Medical evaluation is sometimes necessary to recognize the few children with serious conditions from the majority who have entered puberty early but are still medically normal.

Children (esp. girls) who are obese are more likely to physically mature earlier.

Precocious puberty can make a child able to conceive when very young. Both sexes have become parents before age 10. The youngest mother on record is Lina Medina, who gave birth at the age of 5 years, 7 months and 21 days.

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Synthetic hormone treats precocious puberty - histrelin acetate
From FDA Consumer, 3/1/92

A synthetic hormone called histrelin acetate was approved by FDA on Dec. 30, 1991, to treat central, or unexplained, precocious puberty, in which young children develop the sexual characteristics of adolescents.

About 6,000 American children have this condition, with 2,000 new cases diagnosed each year. Histrelin acetate was developed as an orphan product by Ortho Pharmaceuticals of Raritan, N.J., and will be marketed under the brand name Supprelin. Orphan status provides incentives to companies to develop products for use in conditions that afflict fewer than 200,000 people.

In idiopathic central precocious puberty, the most common form of precocious puberty, sexual development occurs without known cause before age 8 in girls and age 9 in boys. (In other forms, factors such as injury may be involved.) These children at first grow faster than normal, but their bones mature only to a certain state, after which no growth occurs, often with failure to reach full adult height. They also tend to have emotional problems commonly associated with adolescence. Their intellectual development, however, matches their actual age.

Supprelin is given at home by a parent as a daily injection, similar to the way insulin is given to juvenile diabetics. The drug causes hormone levels to return to normal, development of sexual characteristics to stop, and skeletal maturation to decelerate. Full adult height then becomes attainable. Physician labeling and a patient information brochure stress the need to give the injection at the same time each day. Directions warn that puberty will not be controlled if the drug is not administered consistently.

Injections can be stopped when a child reaches the appropriate age for onset of puberty.

In clinical trials involving 183 children, the most frequent adverse effects associated with the drug, occurring in 5 percent of patients, were skin reactions at the injection site such as redness, swelling and itching. In 22 percent of the girls, light vaginal bleeding occurred during the first month. Other infrequent effects included headache, nausea and vomiting.

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