Management of Peripheral Precocious Puberty in Girls
The premature appearance of secondary sexual characteristics like breast development and pubic hair is upsetting and prompts many families to consult endocrinologists. Yet the management of precocious puberty is not always straightforward [1], especially
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Management of Peripheral Precocious Puberty in Girls Charles Sultan, Laura Gaspari, Nicolas Kalfa, and Françoise Paris
The premature appearance of secondary sexual characteristics like breast development and pubic hair is upsetting and prompts many families to consult endocrinologists. Yet the management of precocious puberty is not always straightforward [1], especially given the unusually wide range of clinical expression: most presentations of precocious puberty are peripheral precocious puberty (PPP). • Ten to twenty percent of all cases are instances of central precocious puberty (CPP). The course of its development needs to be carefully assessed and a central tumor must be eliminated. In its typical form, CPP progresses rapidly and the accelerated bone maturation leads to early fusion of the bone plates, thus compromising final adult height. Other clinical presentations have been identified and will be discussed further on. • In 50–60 % of the cases, only one secondary sexual characteristic shows premature development and the diagnosis is premature thelarche (breast development), premature pubarche (appearance of pubic hair). In these cases, the etiology should be sought, and clinical, biological, and radiographic management is devoted to preventing the precocious onset of puberty.
C. Sultan (*) • L. Gaspari • F. Paris Unité d’Endocrinologie-Gynécologie Pédiatriques, Departement de Pédiatrie, Hôpital Arnaud de Villeneuve, CHU Montpellier et Université Montpellier 1, Montpellier, France Service d’Hormonologie (Développement et Reproduction), Hôpital Lapeyronie, CHU Montpellier et Université Montpellier 1, Montpellier, France e-mail: [email protected] N. Kalfa Service de Chirurgie Pédiatrique, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France Service d’Hormonologie (Développement et Reproduction), Hôpital Lapeyronie, CHU Montpellier et Université Montpellier 1, Montpellier, France © International Society of Gynecological Endocrinology 2017 C. Sultan, A.R. Genazzani (eds.), Frontiers in Gynecological Endocrinology, ISGE Series, DOI 10.1007/978-3-319-41433-1_4
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• The development of secondary sexual characteristics has an ovarian cause, with an autonomous hyperproduction of estrogens causing precocious pseudopuberty independently of gonadotropin activation. In more and more cases, it has become evident that the hyperestrogenism may have an exogenous origin such as environmental chemical pollutants in the air, water, and food chain. These xenoestrogens have a chemical structure that mimics the actions of natural estrogens by stimulating the activity of target tissues. In all cases, the initial step is to evaluate the level of estrogen secretion, in terms of both its impact on target organs (breasts, growth rate, bone maturation, etc.) and its course over time. A good understanding of the various ways that precocious puberty clinically presents in girls is vital for the decision on therapeutic management, as the optimal treatment is often not evident during the initial e
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