The document discusses precocious puberty in girls. It defines precocious puberty as the development of secondary sex characteristics before age 8 or menstruation before age 10. Precocious puberty can be caused by premature activation of the hypothalamic-pituitary-ovarian axis or peripheral conditions. Evaluation involves medical history, physical exam, blood tests, and imaging to determine the cause. Treatment options depend on the underlying etiology but may include GnRH agonists to suppress early puberty or other therapies specific to conditions like tumors. With appropriate treatment, prognosis is generally good.

1. PRESENTED BY:-
•DIVYA SHORI
•GEETANJALI NETAM
•HARSH KEDIA
•HEMANT TEKAM
•HIMANI AGRAWAL
•HIMANSHU SUKHDEVE
•ISHA AGRAWAL
•SAKSHI GUPTA

2.  The term precocious puberty is reserved for
girls who exhibit any secondary sex
characteristics before the age of 8 years or
menstruate before the age of 10 years.
 It may be –
Isosexual – due to estrogen
heterosexual-due to androgen
 20 times more common in girls than boys

5.  It is due to premature activation of
hypothalamo-pituitary-ovarian axis
Premature release of GnRH
Secretion of gonadotrophins and gonadal
steriods
Bone maturation accelerated
Premature closure of epiphysis
Reduced stature

6.  Meningitis
 Encephalitis
 craniopharyngioma
 Neurofibroma
 Any tumor - hypothalamic or pineal
gland

7.  Etiology-
 Hyperthyroidism
 Hyperparathyroidism
 Hyperadrenalism
 Acromegaly

8. Pathophysiology-
Mutation of G3 protein
Activation of adenylyl cyclase
Stimulation of LH, FSH ,TSH,GH
First sign is vaginal bleeding

10.  It is the isolated development of
breast tissue before the age of 8.
 Either one or both the breast may
be enlarged.
 There is no other features of
precocious puberty.

11. Precocious puberty in girl aged 2 years and 3 month

12.  It is isolated development of axillary
and pubic hair prior to the age of 8
 There is no sign of precocious puberty
 There may be sign of excess androgen
production due to –
Adrenal hyperplasia
Adrenal tumour
Androgenic ovarian tumour

13.  It is isolated event of cyclic vaginal
bleeding without any other sign of
secondary sexual development.
 Due to unusual endocrine
sensitivity of endometrium to the
low level of estrogens

14.  Meticulous history taking and physical
examinations are essential.
 Basic investigations-
1. Serum hCG , FSH,LH and prolactin.
2. Thyroid profile –TSH and T4.
3. Serum estradiol, testosterone ,17-OH
progesterone .
4. USG ,CT ,MRI of abdomen and pelvis
5. Skull xray ,CT scan , MRI to exclude
intracranial lesion .

15. 6. EEG-Abnormal EEG associated with CNS
disease
7. Xray of hand and wrist for bone age
8. GnRH stimulation test-
100 µg of GnRH is administered (SC)
Serum level of LH is measured
Value of LH >15 mIU/mL
GnRH dependent preocious puberty

16.  Breast buds enlarged to 2-4 cm
 Somatic growth pattern is not
accelerated
 Bone age is not advanced
 Nipple development is absent
 Vaginal smear show negative
estrogen effect

17.  USG –for ovarian enlargement
 USG,CT ,MRI- to detect ovarian and
adrenal tumour
 Serum 17-αhydroxyprogesterone,
DHEA-S and serum testosterone – for
adrenal hyperplasia or tumor

18. 1. To reduce gonadotrophin secretion
2. To supress gonadal steroidogenesis
3. To decrease the growth rate to
normal and slowing the skeleton
maturation
4. To protect the girls from sex abuse
5. Assessment of the speed of
maturation process

19.  GnRH AGONIST THERAPY- drug of
choice for GnRH dependent precocious
puberty
 supresses-FSH ,LH ,
 Reverse the ovarian cycle
 Amenorrhea
 Regression of breast ,pubic hair and other
secondary sexual characters
 Continued till the median age of puberty

20.  DOSE-
 Depot forms- goserelin or leuprolide
(Once a month )
 Leuprolide acetate -7.5 mg 4 weekly
although 3 months regimen are
available

21.  Medroxyprogesterone acetate –
 30 mg daily orally
 Supress –menstruation ,breast
development
 Cannot change the skeletal growth rate
 Precocious puberty of peripheral origin
(ovarian tumour)-specific management

22.  Cortisone therapy –adrenal hyperplasia
 Surgery –to remove adrenal or ovarian
tumour
 Neurosurgery or radiotherapy- intracranial
tumour
 Thyroid replacement therapy –primary
hyperthyroidism

23.  Counseling to parents is essential .
 The girl needs to be protected from
sexual abuse
 Overall prognosis is good with
primary hyperthyroidism ,adrenal or
ovarian tumours
 For CNS group –depends upon
neurological involvement