Precocious Puberty

Normal pubertal development requires activation of the hypothalamic-pituitary-gonadal axis (see Figure 19-3). In girls, the first sign of puberty is typically breast development, occurring between ages 8 and 13 years, followed by the appearance of pubic hair and menarche. In boys, the first sign of puberty is usually testicular enlargement, occurring between ages 9 and 14 years, followed by the appearance of pubic hair and penile growth. Generally speaking, pediatricians and pediatric endocrinologists consider the appearance of secondary sex characteristics to be precocious in white girls prior to age 8 years, in black girls prior to age 7 years, and in boys of any race prior to age 9 years (Rodriguez and Pescovitz 2003).

Within the normal range of pubertal onset, early menarche (prior to 11.6 years) was found to be associated with symptoms of depression and substance abuse (Stice et al. 2001). For both girls and boys participating in a national sample study, pu-bertal development that occurred at the early end of the normal spectrum was associated with undesirable experiences. Among girls who perceived themselves to be early maturing, smoking, dissatisfaction with body image, and early sexual activity were more common compared with their counterparts who considered their pubertal maturation to be

Estrogen Testosterone

Figure 19-3. Hypothalamic-pituitary-gonadal axis.

Gonadotropin-releasing hormone (GnRH) secreted by the hypothalamus stimulates the anterior pituitary to secrete gonadotropins (luteinizing hormone [LH] and follicle-stimulating hormone [FSH]). LH then stimulates the gonads to produce the sex hormones estrogen and testosterone. Sex hormones exert negative feedback to the hypothalamus and anterior pituitary to maintain homeostatic regulation of this axis.

Estrogen Testosterone

Figure 19-3. Hypothalamic-pituitary-gonadal axis.

Gonadotropin-releasing hormone (GnRH) secreted by the hypothalamus stimulates the anterior pituitary to secrete gonadotropins (luteinizing hormone [LH] and follicle-stimulating hormone [FSH]). LH then stimulates the gonads to produce the sex hormones estrogen and testosterone. Sex hormones exert negative feedback to the hypothalamus and anterior pituitary to maintain homeostatic regulation of this axis.

average or late. Boys who considered themselves to be early maturing reported more illicit substance abuse, depression, suicide attempts, eating disorders, and early sexual activity than boys who considered their pubertal maturation to be average or late (Michaud et al. 2006).

In a follow-up study conducted of 16 adolescent girls treated for precocious puberty that included a control group, affected girls reported more psycho-pathological symptoms than unaffected girls (Ehrhardt and Meyer-Bahlburg 1986). A second controlled study revealed that poor body image was associated with precocious sexual development in girls (Officioso et al. 2000). Although limited information exists about the behavioral consequences of precocious pubertal development in girls, even less information is known about boys with this condition.

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