nursing

1. Precocious puberty
DEFINTION :-Precocious puberty is when a child's bodybegins changing into
that of an adult (puberty) too soon. When puberty begins before age 8 in girls and
before age 9 in boys, it is considered precocious puberty.
TYPES
 There are two types of precocious puberty:
central precocious puberty is the morecommontype. Theprocessis
identical to normalpuberty, buthappensearly. Thepituitary gland is prompted
to producehormones, called gonadotropins. Thesehormonesin turn stimulate
the testicles orovaries to make otherhormones, testosteroneorestrogen. It's
thesesexhormones thatcausethechanges ofpuberty,like breastdevelopment
in girls.
 Peripheralprecociouspuberty orprecociouspseudo-pubertyis a different
condition. It'salso rarer. Thehormones estrogenand testosteronetriggerthe
symptoms.Butthe brain and pituitary gland are notinvolved. It's usually a local
problemwith the ovaries, testicles,adrenalgland, ora severely
underactivethyroid gland.
RISK FACTORS
Factors that increase a child's risk of precocious puberty include:
 Being a girl. Girls are much more likely to develop precocious puberty.
 Being African-American. Precocious puberty appears to affect African-
Americans more often than children of other races.
 Being obese. Children who are significantly overweight have a higher risk of
developing precocious puberty.
 Being exposedto sexhormones. Coming in contact with an estrogen or
testosterone cream or ointment, or other substances that contain these
hormones (such as an adult's medication or dietary supplements), can increase
child's risk of developing precocious puberty.
 Having other medical conditions. Precocious puberty may be a
complication of McCune-Albright syndrome or congenital adrenal
hyperplasia — conditions that involve abnormal production of the male

2. hormones (androgens). In rare cases, precocious puberty may also be
associated with hypothyroidism.
 Having receivedradiation therapy of the central nervous
system. Radiation treatment for tumors, leukemia or other conditions can
increase the risk of precocious puberty.
CAUSES CENTRALPRECOCIOUS PUBERTY
In girls, the cause of precocious puberty 90 to 95 percent of the time is idiopathic,
or unknown, Boys are more likely to have an underlying identifiable cause.
Early puberty and sexual development may be caused by:
 central nervous system abnormalities
 family history of the disorder
 certain rare genetic syndromes
 tumors of the pituitary gland or brain
CAUSES PERIPHERALPRECOCIOUS PUBERTY
Peripheral precocious puberty may be caused by:
 certain rare genetic syndromes
 tumors of the ovary or testis
 other tumors that secrete human chorionic gonadotropin
 disorders of the adrenal gland
 severe hypothyroidism
CLINICAL FEATURES:-
Girls:
 Increasing height/growth spurt
 Breast development
 Menstruation or vaginal bleeding
Boys:
 Enlarging testicles and penis
 Pubic and underarm hair
 Facial hair
 Spontaneous erections and/or ejaculations

3.  Development of acne
 Deepening of the voice
COMPLICATIONS
Short height.
Social and emotional problems.
DIAGNOSIS AND MANAGEMENT
Initial evaluation will include
History:- including the onset of symptoms, rate of progression, growth and
family history of PP and diabetes mellitus.
Physicalexamination should include anthropometry and pubertal staging.
Endocrine evaluation should include measurement of LH, FSH, E2 gnrh
stimulation test,
Pelvic ultrasound for ovaries and uterus.
Additional investigations may include measurement of 17
Hydroxyprogesterone (17OHP), DHEAS, Plasma Insulin,Ovaries are
asymmetrically enlarged in PPP.
Cranial magnetic resonance imaging (MRI) should be done in cases of
CPP to exclude CNS pathology.
X-rays, usually ofthe hand and wrist, to checka child's boneage;this is a way
ofseeing how quickly he orshe is growing, and if final adult height might be
impacted.
Treatment
EarlyPuberty:TreatmentOptions
centralprecociouspuberty,medicationscalled GnRHanalogs arethe standard
treatment. They workbyblockingthe hormones comingfromthe pituitary gland that
trigger puberty.
 Injectionsaregiven as monthly shotsinto muscles ordaily shots givenjust
underthe skin.

4.  Implants aretiny tubes -- a little overan inch long -- that are placed underthe
skin, usually in the upperarm. Theygradually release medicine into the body.
 Nasalspraysaregiven daily.
 Progestin.Injections ofprogestinused to bethestandard treatmentforcentral
precociouspuberty.Theyareless effectivethan GnRHanalogs.
 Othertreatments.Surgeryand radiationmight benecessaryin caseswhere
centralprecociouspubertyhas beentriggered bya brain tumor. Removingthe
tumorwon'talways resolveall the symptoms.
TREATING PERIPHERALPRECOCIOUSPUBERTY
Treatment for peripheral precocious puberty depends on what’s causing
excess estrogen or androgen production.
Options include
Tumor removal,
Blocking the actions of estrogen or androgen on the body,
Or treatment of hypothyroidism with replacement thyroid hormone.