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PubMedDate not supplied

Transient central precocious puberty in non-classic 21-hydroxylase deficiency.

A seven year-old boy with non-classic 21-hydroxylase deficiency had transient hormonal evidence of central precocious puberty within three months of beginning glucocorticoid treatment for rapidly progressive somatic virilization. Adrenal-derived sex hormones were normalized promptly by hydrocortisone treatment. GnRH-stimulated LH levels and basal testosterone returned to the prepubertal range without further intervention after six months of glucocorticoid therapy. This is the first report of transient central precocious puberty in the mild non-classic form of congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

17-alpha-Hydroxyprogesterone↗

PubMed1977

Human chorionic gonadotropin produced by ectopic pinealoma in a girl with precocious puberty. Case report.

A case is reported in which a human chorionic gonadotropin (HCG-)-producing ectopic pinealoma was found in a 5-year-old girl with precocious puberty. Physical examination revealed abnormal breast enlargement. Endocrinological study disclosed a high plasma HCG concentration of 1192 ng/ml with a normal follicular stimulating hormone (FSH) level. The HCG content of the tumor was as high as 400 ng/mg of acetone dried tissue, but no FSH was detectable. This is the first reported case of precocious puberty associated with pineal tumor in a female.

Cerebral Ventricle Neoplasms↗

PubMed1996

A case of male-limited precocious puberty caused by a point mutation in the second transmembrane domain of the luteinizing hormone choriogonadotropin receptor gene.

We describe a Japanese patient with male-limited precocious puberty who has a heterozygous thymine to cytosine (T to C) transition at nucleotide 1193; the mutation encodes a methionine to threonine substitution in residue 398 (M398T) of transmembrane helix 2 of the luteinizing hormone/choriogonadotropin receptor. Transfected into COS-7 cells, M398T exhibited constitutively high basal cAMP levels but retained an agonist-induced cAMP response. The constitutively higher cAMP levels caused by M398T are consistent with Leydig cell activation and precocious puberty in the patient. By comparison to wild type receptor, M398T transfectants have significantly lower agonist-induced inositol phosphate (IP) levels at > 10(-10) M hCG concentrations and a higher apparent affinity for binding hCG. These data suggest that the M398T substitution alters Gq coupling and phospholipase-C activation, as well as Gs, coupling and adenylyl cyclase activity, and changes the conformation of the extracellular domain of the receptor.

Amino Acid Sequence↗

PubMed1997

Neonatal hypothalamic c-fos expression in an excitotoxicity-induced model of precocious puberty.

We have used immunocytochemical detection of c-fos expression (FOS-like immunoreactivity, FLI) to establish the site of action of monosodium glutamate (MSG) in neonatal rats in a model of lesion-induced precocious puberty. The primary target appears to be the hypothalamic arcuate nucleus (ARC) but other circumventricular organs (CVO) are also affected (e.g. subfornical organ). Single injections of MSG (1-4 mg/g single dose, postnatal day 2 (P2)) which result in precocious puberty induce an area of edema, surrounded by a ring of FLI in the basal hypothalamus. In contrast, a maximal sub-lethal dose of NMDA (N-methyl-D-aspartate; 3 mg/kg) which produces a different pattern of ARC FLI, without edema, has no effect on puberty. Multiple doses of MSG (4 mg/g P2, P4, P6, P8), consistent with severe ARC damage and resultant sterility, markedly attenuates the FLI response by P8, with no visible edematous reaction following the final injection. In efforts to block the effect of MSG, pretreatment with the NMDA receptor-specific antagonist MK-801 (dizocilpine maleate) prevented the appearance of edema, as well as the onset of precocious puberty. However, MK-801 did not completely eliminate the FLI, but transformed the pattern of staining so that the original edematous area now contained many FOS-positive cells. This remaining MSG-induced FLI could not be eliminated by higher doses of MK-801 or by the non-NMDA antagonist DNQX (6,7-dinitroquinoxaline-2,3-dione). The combination of MK-801 and DNQX was also ineffective. MK-801 or DNQX had no effect on FLI when injected alone (i.e., without MSG) or in combination. The receptor which mediates MSG-induced c-fos expression, in the presence of MK-801 or DNQX, needs to be identified. We conclude, in conjunction with our previous work, that MSG induces precocious sexual maturation via an MK-801-sensitive mechanism associated with an edematous response of the basal hypothalamus. Whether the appearance of edema is indicative of an excitotoxic action of MSG, resulting in the removal of neurons inhibitory to sexual maturation, remains to be established.

Animals↗

PubMed1993

Long-term treatment of central precocious puberty with a long-acting analogue of luteinizing hormone release hormone (D-Tryp6-GnRH) in monthly injections. Its possible use in normal puberty.

The gonadotropin-releasing-hormone-like agonist D-Tryp6-GnRH (GnRHa) has been shown to induce reversible suppression of gonadotropins and gonadal steroids in patients with central precocious puberty. We examined the effect of a long-acting preparation of GnRHa in biodegradable microcapsules. D-Tryptophane6-GnRH, administered intramuscularly at 1 month intervals, for 12 consecutive months, on growth and skeletal maturation in 3 girls and 4 boys with neurogenic or idiopathic precocious puberty. Suppression of gonadotropin release after GnRH stimulation and gonadal steroids was maintained in all subjects. Growth velocity fell from a mean rate (+/- SEM) or 8.60 +/- 0.75 cm/year before treatment to 5.81 +/- 0.60 cm/year (p < 0.005) after 1 year. Bone age advanced a mean of 8.0 +/- 0.45 months during treatment, suggesting an increase in predicted height from the ratio delta bone age/delta chronological age. Two subjects, one of them with compensated Bartter's syndrome with normal hypothalamic pituitary-gonadal-axis, received the analogue to delay pubertal growth with the hope to improve final height. In the first one, the growth velocity fell from 9.9 cm/year to 8 cm/year and delta bone age/delta chronological age decreased from 1.28 to 1.0 and in the other subject, the growth velocity fell from 12 cm/year to 6.0 cm/year in the last year of treatment and delta bone age/delta chronological age fell from 3.2 to 0.75, indicating an improvement in predicted height.

Bartter Syndrome↗

PubMed2000

Etiology of central precocious puberty in males: the results of the Italian Study Group for Physiopathology of Puberty.

We reviewed the hospital records of 45 boys, followed in 13 pediatric departments throughout Italy, who had undergone computed tomography and/or magnetic resonance imaging for central precocious puberty (CPP). Twenty-seven patients (60%) had idiopathic CPP and 18 (40%) neurogenic CPP. A hamartoma of the tuber cinereum was found in six patients (33%). All patients with hypothalamic hamartoma had earlier onset of symptoms than patients with idiopathic CPP. Five patients (27%) were affected by type 1 neurofibromatosis, two had ependymoma and five patients had an intracranial anomaly. Basal LH and basal and peak LH/FSH ratio were greater, but not significantly, in boys with neurogenic CPP than in boys with idiopathic CPP. The highest LH peak levels were observed in patients with hamartoma; however, no correlation was observed between LH peak and the size of the hamartomas. In addition, bone age at diagnosis was more advanced in patients with hamartoma than in patients with other conditions. In conclusion, gonadotrophin-dependent precocious puberty may be of idiopathic origin or may occur in association with any CNS disorder. Further studies are needed in order to evaluate the effects of nutritional, environmental and psychosocial factors on the timing of sexual maturation, to explain the high incidence of idiopathic CPP in our male patients.

Brain Diseases↗

PubMed1981

Gelastic (laughing) seizures and precocious puberty.

Gelastic (laughing) seizures are a rare phenomenon with fewer than 150 cases previously reported. These seizures have been reported to have a benign course in children. This article reviews the small subgroup of seven patients in whom such seizures were associated with precocious puberty and adds one additional case. When gelastic seizures are associated with precocious puberty, the patients often have mental retardation.

Child↗

PubMed1978

Precocious puberty in juvenile hypothyroidism.

Three children, two girls and one boy, presented with hypothyroidism and precocious sexual development. Serum TSH and PRL were elevated in all cases. In the male patient, pituitary stimulation with TRH produced exaggerated TSH and PRL responses. Elevated serum LH, FSH, estrone, estradiol, and an attenuated gonadotropin response to GnRH were documented in the male patient and in one of the female patients. Serum testosterone was elevated for age in one of the female patients but prepubertal in the male patient. After treatment with L-thyroxine, elevated hormonal levels decreased to normal in one patient who returned for follow-up. Evidence is presented that precocious puberty in juvenile hypothyroidism may be the result of PRL hypersecretion.

Adolescent↗

PubMed2006

[Central precocious puberty is associated with a high prevalence of organic disease].

INTRODUCTION: The incidence of central precocious puberty (CPP) is lower in boys than in girls; however, the presence of organic disease is more common in boys. OBJECTIVES: To investigate the percentage of CPP secondary to organic disease in boys and to analyze their clinical and biological characteristics at diagnosis, during follow-up, and at the end of therapy. PATIENTS AND METHODS: Eight boys with a diagnosis of CPP treated with triptorelin every 28 days were included. Age, height in standard deviation (SD), body mass index (BMI) in SD, growth velocity in SD, bone age (Greulich and Pyle), predicted height (Bayle-Pinneau), and target height were analyzed. Testicular volume was measured (according to Prader standards) and peak lutein hormone (LH) values and testosterone levels were determined after gonadotropin-releasing hormone (GnRH) stimulus. RESULTS: Seventy-five percent of the patients with CPP had organic disease. After treatment with triptorelin, growth reduction significantly decreased. In contrast, no changes were seen in the difference between bone age and chronological age, due to the slight difference found at diagnosis. Likewise, during treatment, there was no LH peak and testosterone levels were lower than 0.5 ng/ml in response to GnRH stimulus. No changes were observed in weight or BMI. Three patients reached an adult height similar to their genetic height and their predicted height, as estimated by the Bayle-Pinneau method. CONCLUSIONS: 1. Among boys with CPP we found a substantial number of patients with organic disease. 2. Adult height after treatment with triptorelin can reach the normal range. 3. Determination of testosterone levels can be useful in the follow-up of these children during treatment.

Body Height↗

PubMed2000

Gonadotropin-releasing hormone analog therapy failed to improve predicted final height in two children with central precocious puberty and microcephalus.

Long-acting gonadotropin-releasing hormone (GnRH) analog treatment for central precocious puberty (CPP) suppresses excessive bone maturation by inhibiting the pituitary-gonadal axis, and usually assures favorable results for growth potential. Recently, we encountered two children with CPP and microcephalus in whom GnRH analog therapy arrested pubertal development, but could not suppress bone age maturation effectively. Eventually, their final height deteriorated rather than improved. The reason why these two cases did not respond to GnRH analog therapy remains unknown. However, microcephalus and minor cerebral anomalies may have some links to deterioration of final height. Our cases suggest that careful evaluation will be required especially for CPP with microcephalus throughout treatment with GnRH analog.

Adolescent↗

PubMed2000

Adolescent girls with idiopathic central precocious puberty: typical character traits.

It has been reported that girls at onset of idiopathic central precocious puberty (ICPP) and during treatment have symbiotic character traits. The aim of this study was to investigate the development of character in a group of adolescents. Ten adolescent girls aged 14 years treated for ICPP were evaluated. All the adolescents in the study had a negative body image compared with age-matched controls and expressed a strong inhibition of their femininity. Their poor body image is reflected by their limited self-esteem. These adolescents have not been able to operate a reorganization of their affective life and therefore go through the necessarily slow and painful separation from their family. Symbiotic traits are "hard-wired" into their lives. These results suggest that at ICPP onset, in addition to setting up an educational program for the parents, it is equally important to supply psychological support for the patients in order to gain a better interaction between biological, psychological and cultural influences.

Brain Diseases↗

PubMedDate not supplied

hCG-secreting pineal teratoma causing precocious puberty: report of two patients and review of the literature.

Two boys are described with precocious puberty (PP) due to pineal immature teratoma associated with choriocarcinoma. Patient 1 was a 7 year-old boy with a 2-year history of PP. He had elevated CSF and plasma beta-hCG levels. Magnetic resonance imaging (MRI) showed a 3.0 cm pineal mass. He was initially submitted to a trial with radiotherapy, followed by radical surgical resection, stereotactic radiotherapy and chemotherapy. Long-term follow up included the appearance of acute hydrocephalus requiring CSF shunting, local hemorrhage and extensive radionecrosis. Death occurred 1.5 years after diagnosis. Patient 2 was a 7 year-old boy with an 8-month history of PP. He had elevated CSF and plasma beta-hCG and alpha-fetoprotein levels. MRI showed a 1.0 cm pineal mass. He was submitted to radical surgical resection (which caused normalization of levels of markers) and prophylactic chemotherapy. The boy is doing well 1.5 years after diagnosis. An extensive review of the literature corroborates the idea that this last treatment paradigm (surgery and chemotherapy) probably represents the best treatment regimen for these patients.

Child↗

PubMed1990

Urinary excretion of [D-Ser(t-Bu)6,Des-Gly10]GnRH ethylamide (buserelin) during therapy of central precocious puberty: a multicentre study.

In order to compare the clinical effects of buserelin on central precocious puberty to its excretion in urine, as a parameter of metabolism or compliance, we have studied 52 patients treated either sc or intranasally. In girls with good control, urinary buserelin excretion represented 0.5 +/- 0.1% of the daily intranasal dose vs 12.5 +/- 2.3% of the daily sc dose. In boys, it represented 0.8 +/- 0.2 and 9.9 +/- 2.7%, respectively. In the sc treated group, 3 patients (2 girls and 1 boy) with poor control who exhibited excretion levels similar to those with good control were classified as resistant to therapy. Clinical control was poor in 4 intranasally treated girls: 2 had low excretion values suggesting poor compliance or failure of absorption by the nasal mucosa, and 2 appeared resistant to therapy, as urinary excretion levels of buserelin were similar to those of well-controlled patients. In addition, these data suggest that the small amount of buserelin absorbed by the nasal mucosa, as expressed by urinary excretion, is sufficient to desensitize the pituitary gonadotropes without any significant first-pass effect in the systemic circulation. This may explain the clinical effectiveness of the intranasal route for administration of small hormonal peptides acting on the pituitary gland.

Administration, Intranasal↗

PubMed2005

Combined therapy with luteinizing hormone releasing hormone agonist (LHRHa) and growth hormone (GH) in central precocious puberty.

Luteinizing Hormone Releasing Hormone analogues (LHRHa) are considered the treatment of choice in central precocious puberty (CPP). Final height after therapy is usually higher than the predicted one before treatment, but about 60% of patients do not reach their genetic target. The association of Growth Hormone (GH) with LHRHa could be useful in a subgroup of children with CPP and low growth velocity in order to obtain a higher final height with a complete expression of genetic potential. Moreover, in children with early puberty adopted from developing countries, predicted adult height is significantly greater when the combined therapy, GH and LHRHa, is employed. In this paper the rationale for adding GH to LHRHa is discussed and the clinical reports from the literature are presented.

Drug Therapy, Combination↗

PubMed1982

[The succession of precocious puberty and Stein-Leventhal syndrome].

The authors relate the observation of a girl with precocious puberty diagnosed at 4 years, treated for 7 years with medroxyprogesterone and who presents now a Stein-Leventhal syndrome. They emphasize the unique character of this association and discuss the different pathogenetic hypotheses: hypothalamo-pituitary disorder, effect of medroxyprogesterone acetate, hyperinsulinism, casual association.

Androstenedione↗

PubMed1975

[Pathophysiology of gonadotropin secretion in patients with idiopathic precocious puberty and follow up studies during and after therapy with medroxyprogesterone acetate (author's transl)].

In order to assess the pathophysiology of gonadotropin secretion in patients with idiopathic precocious puberty, responses of LH and FSH to LH-releasing hormone (LH-RH), clomiphene citrate (Clomid) and medroxyprogesterone acetate (Deop-provera) in 6 female patients were tested. The basal levels of serum LH and FSH were elevated in 4 of 6 patients and enhanced LH response to 100 mug of intravenous LH-RH was observed in 5 patients, while FSH response was comparable to that of prepubertal subjects. Administration of Clomid (50 mg) for 7 days provoked LH increase in 3 out of 6 patients in contrast to no LH change found in normal prepubertal girls. while FSH levels decreased in 3 out of 6 patients. Intramuscular injection of Depo-Provera (100 mg) reduced LH and FSH levels in 4 patients. The Depo-Provera therapy in a dose of 75 approximately 225 mg every two weeks, caused suppression of breast development and menstrual bleeding but the prevention of growth spurt and bone age maturation were insufficient. Basal body temperature charts in 2 patients showed an ovulatary pattern immediately following cessation of Provera therapy of more than 8 years' duration. In conclusion, it is suggested that 1) function of hypothalamo-pituitary-ovarian system in patients with idiopathic precocious puberty is similar to that of normal pubertal subjects, 2) therapeutic doses of Depo-Provera, enough to suppress the patients' secondary sex characterics, was not sufficient to control bone age maturation 3) it is necessary to follow up patients more closely by measuring serum levels of gonadotropin and estrogen during the course of therapy.

Child↗

PubMed1994

[Long-term therapy of true precocious puberty in girls using Decapetyl-Depot, a superactive gonadoliberin agonist in depot microcapsulated form].

Within the framework of an international prospective multicentre study 93 girls with gonadotropin-dependent precocious puberty were treated with Decapeptyl-Depot LHRH agonist (75 micrograms/kg, once a month by the i.m. route). This treatment led to prompt, immediate and long-term suppression of the pituitary-ovarian axis with subsequent regression of premature onset of secondary sex signs, to the arrest of premature menstruation, to normalization of the pathologically accelerated growth and inhibition of the accelerated bone maturation. This improved the mean expected growth during the first four years of treatment from 159 to 165 cm (p < or = 0.01). Concurrently in the majority complete normalization of the severely impaired mental condition of the affected girls due to the premature onset of puberty occurred (mean onset of puberty -4.5 years). Selective suppression of the pubertally increased gonadotropin secretion was even after prolonged treatment fully reversible after termination of treatment with a subsequent onset of normal puberty and cyclic ovarian activity. Undesirable side-effects and antibodies against Decapeptyl were not detected, the local tolerance of the injected microcapsules was satisfactory. GnRH agonists in depot form are becoming, due to their superior suppressive action incl. that on bone maturation, the drug of choice in long-term treatment of central precocious puberty as they are the first which mitigate or can prevent, if treatment is started in time, a final small stature which frequently is the greatest handicap for a life-time (frequently associated with adverse bodily disproportions).

Child↗

PubMed1989

[Treatment of precocious puberty with an LH-RH agonist (D-TRP6-LH-RH)].

Chronic administration of luteinizing hormone-releasing hormone (LH-RH) is currently considered as the most appropriate therapy of precocious puberty. A delayed release preparation of D-Trp-6-LH-RH (Décapeptyl in microcapsules) designed to release the agonist for 28 days after intramuscular injection of 60 micrograms/kg body wt was given to 12 boys and 26 girls with precocious puberty. Plasma levels of gonadotropins and sex steroids were suppressed to prepubertal levels within 3 weeks, whilst pituitary responses to LH-RH test were almost abolished within 7 weeks. A significant improvement of secondary sex characteristics, as well as gonadal size, was observed within 6 months. Growth velocity (cm/yr, mean +/- SD) was reduced in boys and girls from 9.9 +/- 3.4 and 9.6 +/- 3.3 respectively before treatment to 5.2 +/- 1.0 and 5.3 +/- 1.3 respectively during the third year of treatment. The mean ratio height age/bone age was just before treatment 0.91 in boys and 0.88 in girls and increased to 1 after 3 yr of treatment. This study shows that Décapeptyl in microcapsules induced a prolonged suppression of gonadal function and a relative blockade of bone maturation. A significant improvement of adult height relative to the effect of conventional treatments should be expected.

Female↗