Precocious puberty

　　The causes of precocious puberty are as follows:

　　Firstly, true precocious puberty

　　Common causes of true precocious puberty (also known as GnRH-dependent precocious puberty) include: central nervous system tumors (such as optic chiasm glioma, hypothalamic astrocytoma, teratoma, etc.), non-tumor lesions in the central nervous system (such as the gray node, Williams syndrome, encephalitis, brain abscess, tuberculous granuloma, trauma, brain edema, arachnoid cyst, and cranial radiotherapy after treatment, etc.), and treatment after congenital adrenal cortical hyperplasia.

　　1. Idiopathic precocious puberty: also known as constitutional precocious puberty.

　　2. Secondary precocious puberty: secondary to central nervous system diseases. Tumors located in the hypothalamus, such as hypothalamic hamartoma, glioma, craniopharyngioma, etc.

　　Secondly, pseudo-precocious puberty

　　Common causes of pseudo-precocious puberty (also known as non-GnRH-dependent precocious puberty) include: tumors secreting gonadotropin (such as choriocarcinoma or teratoma secreting human chorionic gonadotropin, liver tumors secreting LH-like substances), congenital adrenal cortical hyperplasia (CYP21, CYPllβ1 deficiency), adrenal androgenizing tumors, Leydig cell tumors, follicular cysts and ovarian tumors (granulosa cell tumors, theca cell tumors, etc.), McCune-Albright syndrome, hypothyroidism, excessive exogenous androgens or estrogens, and so on.

　　There are two types of situations where malignant tumors cause precocious puberty due to the production of gonadotropin:

　　1. Choriocarcinoma or teratoma (ovary, testis, mediastinum) produce chorionic gonadotropin, which has a similar effect to luteinizing hormone (LH).

　　2. Liver cancer produces substances similar to LH, under the action of these substances, the interstitial cells of the testis are excited, resulting in excessive testosterone production.

　　The above malignant tumors can only produce one type of gonadotropin and cannot cause true precocious puberty, thus they are pseudo-precocious puberty, including:

　　1. Gonadal tumors (such as ovarian granulosa-theca cell tumors, luteal granulosa cell cysts, McCune-Albright syndrome, testicular Leydig cell tumors, etc.) secrete autocrine hormones.

　　2. Congenital adrenal hyperplasia, adrenal tumors. Most produce excessive androgen precursors and transform them into androgens.

　　3. Severe hypothyroidism, with insufficient thyroxine, increased secretion of thyrotropin-releasing hormone (TRH) and gonadotropin, leading to precocious puberty.

　　4. Multiple bone fibrous dysplasia, also known as McCune-Albright syndrome, may be related to cranial lesions. When the lesion is located in the second ventricle, due to the abnormal hyperplasia of bone, it protrudes inward, stimulating the pituitary to secrete excessive gonadotropin, leading to precocious puberty.

　　3. From the perspective of diet

　　1. Tonifying food

　　Such as Cordyceps sinensis, ginseng, dried longan, dried lychee, Astragalus membranaceus, Adenophora, etc.

　　Perhaps many parents think these are good things, so in order to allow their children to grow up better, they add these things to their children's daily diet.

　　2. Fish, meat, and poultry

　　The fish, meat, and poultry food sold on the market is basically grown by 'ripening agents' (animal growth hormones). After these chickens, ducks, and fish are slaughtered, there are still a large amount of hormones in their bodies. When children eat these, the hormones残留 in the meat products are absorbed by the human body, promoting the premature development and maturation of children.

　　3. Out-of-season vegetables and fruits

　　The out-of-season fruits and vegetables, and the fish, meat, and poultry on the market, are all grown and harvested with the help of 'plant growth hormones' and other hormones. Similarly, these out-of-season fruits and vegetables naturally also contain hormones, so they will also be absorbed and utilized by children. Therefore, in order for children to grow up healthily, parents must keep their children away from out-of-season vegetables and fruits.

　　4. Fried foods

　　With the rise of Western fast food chains like KFC and McDonald's in China, they have filled every corner of the city. Many children have fallen in love with fried chicken, burgers, fries, and other high-calorie, high-fat junk food due to these chain stores. Especially the residual hormones in the food can cause great harm to children.

　　5. Children's health products

　　Nowadays, many merchants have seized the opportunity to cater to parents' desire for their children to grow faster than others and to be 'taller' than others, and have launched some so-called children's health products that can help with bone development and make children grow taller quickly. However, the盲目 use of these products has caused abnormal results in children's development.

　　Currently, in clinical practice, drugs such as progesterone, luteinizing hormone-releasing hormone, and other drugs are often used to treat precocious puberty, although they have certain efficacy, they also have certain side effects. So, what specific complications does precocious puberty have?

　　1. Dwarfism Due to the rapid growth of bones, the growth cycle of children with precocious puberty will be significantly shortened, with insufficient time for development, ultimately resulting in a shorter height than the general population after adulthood. About half of the children with true precocious puberty may have a final height of less than 150cm.

　　2. Psychological disorders Children with precocious puberty may, due to their different physical appearance and appearance from their peers, bear the heavy burden of thoughts too early, and produce feelings of inferiority, fear, and unease, which may have a long-term adverse effect on their mental health in the future.

　　3. Endocrine disorders Precocious puberty is itself an endocrine disease, but the degree of endocrine imbalance in the child varies individually, that is, there are differences in severity and urgency. Children with mild symptoms mainly show a disorder of sex hormone levels, while children with severe symptoms may lead to or be accompanied by other endocrine dysfunction, resulting in more clinical manifestations.

　　4. Other This disease can also be complicated with toxic or non-toxic goiter, acromegaly, Cushing's syndrome, gynecomastia in males, etc., which may be due to congenital hypothalamic abnormalities leading to pituitary dysfunction.

　　In females, there are breast development, enlargement of the labia minora, estrogen-dependent changes in vaginal mucosal cells, enlargement of the uterus and ovaries, the appearance of pubic hair, and the onset of menstruation; in males, there are enlargement of the testicles and penis, the appearance of pubic hair, muscular development, and a deepening of the voice.

　　Both males and females have accelerated growth and bone maturation, which can ultimately lead to a final height lower than the target height. In cases with intracranial tumors and other central nervous system lesions, there may be symptoms such as headache, vomiting, changes in vision, or other neurological symptoms and signs.

　　1. To prevent the occurrence of precocious puberty, parents should also pay attention to giving children less chicken, beef, mutton, silkworm pupae, and other foods, and do not abuse so-called children's food that has not been strictly tested.

　　2. Do not give children excessive nutritional supplements, such as royal jelly, pollen preparations, chick embryo, and other 'medicines', and properly store contraceptives, breast enhancement beauty products, etc., to prevent the child from accidentally taking them or coming into contact with them.

　　3. Early detection and timely treatment. In addition to mastering the necessary medical knowledge, parents should pay more attention to observing whether the child has early appearance of secondary sexual characteristics, sudden acceleration of height growth in children under 10 years old, and other phenomena. Once an abnormality is found, it should be treated promptly and a visit to a regular hospital should be made.

　　4. Children with precocious puberty should be educated about menstrual knowledge and hygiene, and sex education should start as early as possible according to the child's understanding.

　　In summary, if a child shows signs of precocious puberty, parents must relieve their concerns, analyze the cause, explain patiently, do not let the child bear psychological burdens, and actively cooperate with the doctor for careful examination and treatment. In this way, children with precocious puberty can still develop normally and will not affect their future marriage and childbearing.

　　Patients with precocious puberty should have a detailed and complete medical history, including the development of sexual characteristics, vaginal bleeding, and whether they have taken endocrine drugs. Other examination methods mainly include the following:

　　1. Plasma FSH, LH measurement: The baseline values of plasma FSH and LH in children with idiopathic precocious puberty may be higher than normal, often difficult to judge, and it is necessary to rely on the GnRH stimulation test, also known as the luteinizing hormone-releasing hormone (LHRH) stimulation test. Generally, intravenous injection of Gnrh is used, with a maximum dose of 2.5μg/kg, not exceeding 100μg. Serum LH and FSH levels are measured at 30, 60, 90, and 120 minutes after injection (basal value). When the peak value of LH is greater than 15U/L (female) or greater than 25U/L (male); the peak value of LH/FSH is greater than 0.7, and the peak value of LH/basal value is greater than 3, it can be considered that the function of the gonadal axis has been initiated.

　　5. Bone age determination: According to the X-ray film of the hand and wrist to evaluate the bone age, and whether the disk bone development is ahead of schedule. Children with precocious puberty generally have a bone age beyond their actual age.

　　6. Ultrasound examination: Choose pelvic ultrasound examination for the development of girls' ovaries and uterus; for boys, pay attention to the testicles and adrenal cortex and other parts. If the pelvic ultrasound shows multiple ovarian follicles ≥4mm, it is considered precocious puberty. If a single follicle with a diameter greater than 9mm is found, it is mostly a cyst. If the ovary is not large but the uterine length is greater than 3.5cm and the endometrium is thickened, it is mostly due to the effect of exogenous androgens.

　　7. CT or MRI examination: For suspected intracranial tumors or adrenal diseases, cranial or abdominal CT or MRI examination should be performed.

　　8. Other examinations: According to the clinical manifestations of the child, other examinations can be further selected, such as measuring T3, T4, and TSH if suspected of hypothyroidism, increased testosterone and estradiol concentration in sexual gland tumors, and significantly increased 17-hydroxyprogesterone (17-OHP) and 17-ketosteroids (17-KS) in children with congenital adrenal cortical hyperplasia.

　　The causes of precocious puberty in children are very complex, and it is undeniable that dietary factors are the most common, especially in the era when food is also 'high-tech'. Parents must not ignore it. The following are dietary taboos for precocious puberty:

　　1. Avoid medicinal tonifying foods that can be taken as medicine, including Cordyceps sinensis, ginseng, dried longan, dried lychee, Astragalus, and Schisandra chinensis. Especially Guangdong people, who like to make soups with medicinal diet. Traditional Chinese medicine points out that the more tonifying the medicinal diet, the more it will change the child's normal endocrine environment, causing an imbalance in physical and mental development.

　　2. Avoid poultry meat, especially chicken necks. Most of the poultry sold in the market are fed with feed mixed with rapid-growth agents. The residue of growth promoters in poultry meat mainly concentrates in the glands of the chicken neck and head. Therefore, eating duck necks and goose necks has become a high-risk behavior for promoting early maturation.

　　3. Avoid out-of-season vegetables and fruits. For example, strawberries, grapes, watermelons, tomatoes in winter, and pears, apples, oranges, and peaches sold before the end of spring are almost all matured prematurely or early with the help of growth promoters. It is necessary to avoid giving these to children under 10 years old.

　　4. Avoid fried foods, especially fried chicken, French fries, and potato chips, as their high calorie content can be converted into excess fat in children's bodies, causing endocrine disorders and leading to precocious puberty; in addition, after repeated heating, cooking oil can be oxidized and denatured at high temperatures, which is also one of the causes of precocious puberty. Children who visit fast food restaurants twice a week or more and often eat fried and puffed snacks have a 2.5 times higher chance of precocious puberty than ordinary children.

　　Premature puberty refers to the significant advance in the onset age of childhood sexual development, usually referring to the age at which male and female children show the initial characteristics of sexual signs (such as breast development in girls, and enlargement of external genitalia in boys) is more than two standard deviations earlier than the average age of normal children. It is called childhood premature puberty. It is still widely believed worldwide that girls before the age of 8 and boys before the age of 9 showing secondary sexual characteristics can be clinically diagnosed as premature puberty.

　　Not all premature puberty requires treatment

　　Indications for not needing treatment: 1. Slow sexual maturation process (bone age progression does not exceed age progression) with no significant impact on adult height. 2. Although the bone age is advanced, the growth rate of height is also fast, and the predicted adult height is not damaged. Because adolescence is a dynamic process, the above indicators for each individual need to be observed dynamically. For those who do not need treatment temporarily, regular reexamination and evaluation are required, and the treatment plan should be adjusted.

　　The goal of treatment is to suppress early or rapid sexual development, prevent or alleviate the social or psychological problems (such as early menarche) caused by premature puberty in children or parents. Improving the adult height reduced by the advance of bone age is also an important goal. GnRH analogs (GnRHa) are the current main treatment option, and the commonly used preparations include the sustained-release preparations of triptorelin and leuprolide.

　　Most premature puberty can be cured, but early detection and timely treatment are very important. As long as early detection and timely treatment are achieved, patients with premature puberty can obtain normal psychological state and expected adult height, and the earlier the treatment, the better the effect. How to detect child premature puberty early? In addition to paying more attention to observing whether the child has early secondary sexual characteristics in daily life, a sudden acceleration in the growth of the child's height before the age of 10 is often a sign of premature puberty. At this time, parents should not be blind乐观. When parents suspect that their child has a problem in this regard, they should take their child to the hospital for consultation and treatment in time to avoid missing the best treatment opportunity. If girls wait until menstruation starts and boys wait until they have started to change voice, have a Adam's apple, and develop acne before starting treatment, it is too late for improving height.