One of the most frequent reasons for consultation in pediatric and pediatric endocrinology consultations is the suspicion of precocious puberty. In most cases it is not a true advanced puberty, but some variant of normality. It is a subject that causes a lot of concern in parents. We will try to define the normal of the pathological and to solve doubts.
The first thing is to define what puberty is. It involves the maturation of the human body for the development of sexual characters in order to achieve ovulation or spermatogenesis. It is not something that happens in a day, but it takes years to establish itself, and it does so little by little.
Let's differentiate it according to sex as normal puberty develops:
- Children: the age of onset to be considered normal is between 9 and 14 years. It begins with an increase in the size of the testicles, followed by the appearance of hair in the pubis (pubarche) and changes in the penis. Approximately two years after pubarche, axillary hair appears and the stretch is given.
- Girls: the normal age is between 8 and 13 years. First appears the breast button and the thelarchy, along with an increase in height, followed by pubic hair and months later the axillary. Two years later the first menstruation will come (menarche). It is true that each day is presented at a younger age.
exist normal variants that can startle parents and that should be specified. Often newborn girls can have a small period due to the passage of maternal estrogens. Newborns of both sexes may also have breast augmentation for the same reason, which will decrease in the coming months.
Telarquia may appear at any age, which is increasing and disappearing, but as long as it is not accompanied by other pubertal signs it does not matter. The boys when they give the stretch can also present a breast augmentation that takes 1 or 2 years to disappear.
The early puberty It is the beginning of the signs commented ahead of time. It may be for many causes, but most are unknown. In all cases, the endocrine should be consulted to rule out any alteration. Nowadays a very frequent factor in the advancement of development in girls is obesity. Excess fat is transformed into estrogens that trigger the entire process. The more overweight the bone matures faster.
If it is too advanced and could affect the child's final size, a hormonal treatment can be done to stop it.
The late puberty Not only is the non-onset of pubertal signs, but also the non-appearance of all signs. For example, the one that does not appear menstruation in a girl of 16 years.
It may be due to a constitutional growth delay, which is also considered a variant of normality without further ado and is usually accompanied by a smaller than normal size and slower growth, but in the end a good size and development is achieved complete (usually there is almost always a family history) or that there is some cause, so these cases also always require endocrinological study.
It can be treated with estrogens in the cases of girls and testosterone in boys in very important cases.
I hope I have clarified doubts and reassured many parents.
