Signs and Symptoms Since both central and peripheral precocious puberty is caused by a premature secretion of androgens and estrogens, most clinical features are normal pubescent signs of the development of secondary sexual characteristics. Although the signs and symptoms of adolescents who have central precocious puberty develop not only due to an increase in androgens and estrogens, but also due to an increase in GnRH from the hypothalamus and LH and FSH from the anterior pituitary, and those who develop peripheral precocious puberty only reveal symptoms from an elevated secretion of androgens and estrogens, the physical clinical features are mostly identical. In females, common signs are early breast development, hyperpigmentation of areola,
…show more content…
In central precocious puberty, the main goal in treatment is preserving the height potential in adolescents. Positive outcomes have been seen when using GnRH or GnRH antagonist, such as leuprolide acetate. By providing a continuous secretion of GnRH or GnRH antagonist, instead of the usual endogenous pulsatile secretion, downregulation and suppression of hypothalamus-pituitary-gonadal axis is seen. Another method of GnRH antagonist injection is the use of histrelin implants. Placed subcutaneously and most commonly in the inner upper arm, the implant is filled with histrelin, which is a GnRH antagonist, and set to deliver 65 µg/day to those affected with central precocious puberty. The treatment has been proven to suppress LH and FSH levels, which further accompanies suppression of pubertal signs. Although very efficient, the most common adverse effect of using a histrelin implant is breaking the implant or having difficulty finding it in the body. Since the main treatment goal in central precocious puberty is assuring normal adult height, oxandrolone has been injected in some patients to improve growth. Although the exact mechanism is still unclear, it is hypothesized that the drug has some positive effects on the growth plate. When combined with GnRH antagonist, it has been seen to improve adult height, when compared to just GnRH alone. Also, when GnRH antagonist and growth hormone (GH) are combined and used for treatment, improvement in adult height has been noted (Chen 2015). Another form of treatment is the use of aromatase inhibitors. Aromatase is an enzyme that catalyzes the reaction from androgens to estrogens. These inhibitors have proven to lessen the effects of estrogen on bone maturation, as well as delay the fusion of epiphyseal plate, which is a determinant in completion of linear growth (Lee
In central precocious puberty, the main goal in treatment is preserving the height potential in adolescents. Positive outcomes have been seen when using GnRH or GnRH antagonist, such as leuprolide acetate. By providing a continuous secretion of GnRH or GnRH antagonist, instead of the usual endogenous pulsatile secretion, downregulation and suppression of hypothalamus-pituitary-gonadal axis is seen. Another method of GnRH antagonist injection is the use of histrelin implants. Placed subcutaneously and most commonly in the inner upper arm, the implant is filled with histrelin, which is a GnRH antagonist, and set to deliver 65 µg/day to those affected with central precocious puberty. The treatment has been proven to suppress LH and FSH levels, which further accompanies suppression of pubertal signs. Although very efficient, the most common adverse effect of using a histrelin implant is breaking the implant or having difficulty finding it in the body. Since the main treatment goal in central precocious puberty is assuring normal adult height, oxandrolone has been injected in some patients to improve growth. Although the exact mechanism is still unclear, it is hypothesized that the drug has some positive effects on the growth plate. When combined with GnRH antagonist, it has been seen to improve adult height, when compared to just GnRH alone. Also, when GnRH antagonist and growth hormone (GH) are combined and used for treatment, improvement in adult height has been noted (Chen 2015). Another form of treatment is the use of aromatase inhibitors. Aromatase is an enzyme that catalyzes the reaction from androgens to estrogens. These inhibitors have proven to lessen the effects of estrogen on bone maturation, as well as delay the fusion of epiphyseal plate, which is a determinant in completion of linear growth (Lee