Gonadotropin-Independent Precocious Puberty

What is gonadotropin-independent precocious puberty?

Puberty that happens early is called precocious puberty. This means a child's physical signs of sexual maturity develop too soon. This includes breast growth, pubic hair, and voice changes. These are known as secondary sexual characteristics. The sex glands (ovaries and testes) don't mature early. Precocious puberty happens before age 8 in girls and before age 9 in boys. Gonadotropin-independent precocious puberty is caused by high levels of sex hormones. These include the male androgens and female estrogens.

Gender words are used here to talk about anatomy and health risk. Please use this information in a way that works best for you and your provider as you talk about your care.

What causes gonadotropin-independent precocious puberty?

The condition may be caused by:

• Tumors on the ovaries or testes

• Tumors in other places in the body

• Contact with estrogen or testosterone in cream, ointment, or spray. For example, if a caregiver is using estrogen cream for menopause.

• Eating food contaminated with estrogen or estrogen-like substances (such as in soy)

What are the symptoms of gonadotropin-independent precocious puberty?

The signs are secondary sexual characteristics that happen early.

Common signs in girls can include:

• Breast growth

• Pubic and underarm hair

• Menstruation

• Body odor

Common signs in boys can include:

• Growth of facial, underarm, or pubic hair

• Lengthening of penis

• Enlargement of one or both testes

• Body odor

• Acne on face or body

• Spontaneous erections

• Looking more masculine

Sometimes the child will begin to develop sexual changes of the opposite sex. For example, a boy may have breast growth.

The signs of gonadotropin-independent precocious puberty can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

How is gonadotropin-independent precocious puberty diagnosed?

The healthcare provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. Your child will have a physical exam and some tests, such as:

• Blood tests. These are done to measure hormone levels.

• X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist. This can estimate your child's bone age. With precocious puberty, bone age is often older than calendar age.

• Ultrasound (sonography). This test uses sound waves and a computer to create images of blood vessels, tissues, and organs. This may be done to look at the adrenal glands and ovaries or testes.

• MRI. This test uses large magnets and a computer to make detailed images of tissues in the body.

How is gonadotropin-independent precocious puberty treated?

The goal of treatment is to stop the onset of early puberty signs. In some cases, the signs can be reversed. Treatment may include medicines that block the action of the sex hormones. If a tumor is causing the problem, surgery may be needed to remove the tumor.

What are possible complications of gonadotropin-independent precocious puberty?

Without treatment, a child will not attain their full expected height. A young girl may also have distress because of early menstruation. Boys and girls may be very upset because of the early physical changes. If a tumor is the cause of the condition, the tumor may also cause other problems.

How can I help my child live with gonadotropin-independent precocious puberty?

A child may have social or emotional problems trying to deal with the body changes. Work with your child's healthcare provider to help manage your child’s condition. This may include joining a support group or talking with a counselor. Be aware of your child's school and social media activities. Be alert for signs of bullying. Intervene when needed.

When should I call my child's healthcare provider?

Call your child’s healthcare provider if you see sexual signs in a girl before age 8 or in a boy before age 9.

Key points about gonadotropin-independent precocious puberty

• Puberty that happens early is called precocious puberty. This means a child's physical signs of sexual maturity develop too soon. Precocious puberty happens before age 8 in girls and before age 9 in boys.

• Signs can include breast growth, pubic hair, and voice changes. 

• Gonadotropin-independent precocious puberty is caused by high levels of sex hormones. These include the male androgens and female estrogens. The sex glands (ovaries and testes) don't mature early.

• It may be caused by tumors or growths on the ovaries, testes, or other places in the body. It may also be caused by contact with estrogen or testosterone cream or ointment.

• The goal of treatment is to stop the onset of early puberty signs. In some cases, the signs can be reversed. Treatment may include medicines that block the action of the sex hormones.

• If a tumor is causing the problem, surgery may be needed to remove the tumor.

• Without treatment, a child will not attain their full expected height and may have social or emotional problems because of going through puberty before others their own age.

• Individual counseling or support groups may help a child cope with the physical changes

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.