Pediatric Endocrinology Expert Forum
Precocious Puberty
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Questions in the Pediatric Endocrinology forum are answered by Dr. Deanna L Aftab Guy. Topics covered include adrenal problems, diabetes insipidus, menstrual irregularities, obesity, parathyroid abnormalities, pituitary abnormalities, puberty concerns, rapid growth, rickets and bone disease, short stature, and thyroid.

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Precocious Puberty

My 6 years old daughter started having symptoms of Precocious Puberty (premature adrenarche) about a year ago, when she was 5, first there was the manifestation of very fine pubic hair, then on and off armpit odor and now small breast buds with ticker pubic hair.  She is also the tallest kid in her class and is chubby.  We have an appointment with and endocrinologist in a few days.  X-Ray for bone age and blood work to check hormones and thyroids function has been done at the pediatricians’ request (still waiting for results).  Needless to say we are very worry about the physical and psychological impact this can have on her development.

Can you please guide us as to what kind of question should we bring forward to the endocrinologist?
Can you tell me a little about the drugs used to stop puberty from continuing?
If our daughter is put on any of this drugs.  Will she continue to grow normally?
Will the drugs stop her from having her period so early?
What other option besides drugs are there to help her?

We have changed her diet to only organic milk and no red meat.  We are also encouraging her to eat less and more healthy as well as doing more exercise.  Is the exercise a good approach? She is sweating more and I am afraid, whether this is advisable giving her condition.

Also, what kind of deodorant is best for a child her age?  I don’t want to use something that can bring her more problems in the future.

Thanks in advance!
Mary
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You should not fret as much about the diet in regards to organic, she is having an early tempo to some normal processes. The endo more than likely will get blood and may want to see the bone age or do their own, what they need to tell is firstly if the adrenarche is due to abnormal reasons(bloodwork helps tell) and also if this has now turned on true puberty signals from the brain to the ovary, sometimes a special test is needed which is set up at a different time to tell if the signal is mature from the brain, hormone levels are measured before and after giving a medicine called leuprolide, also the adrenal gland function is measured simililarly in certain cases before and after a med called acth.
These are referred to as stim tests and are something that if necessary you will talk about with your doc, but first let them examine her.
Her weight is very very important in all of this, her body weight will drive things further in regards to increasing insulin which may drive the adrenal gland, the adrenarche is mostly a nuisance if benign causes and use of deodorant and if needed trimming the hair under the arms so she can wear sleeveless clothing is all that you would have to do to treat.
If it is indeed early puberty treatment is with lupron a monthly injection or recently there is a little more intricate treatment called histrelin which is an implant that not all of us place, a little harder to orchestrate, treatment continues till she is age appropriate(10 in most cases) and then after treatment is done we allow the girls to progress as usual, within about 9-12 months after that most girls show signs again of normal progression of puberty.
The goal is two things, firstly we don't want our kindergartner having her period!
Second her final height can be compromised if allowed to progress rapidly through puberty and what appears to be a taller than her friends child will soon fall behind, this is how the bone age helps us determine this and we repeat this yearly or sooner to track the progress at that level.
Deodorant, honestly get the teen kind(Hannah Montana actually has her own brand!) It will help her fit in with her friends and give you peace of mind!
Good luck, keep your appt, it is hard to get in trust me, we are 3-4 months waiting list :)
6 Comments
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Thanks a lot!!  I really appreciate your prompt respond.  Of course I will keep the appointment, and I will also try to post some details of the same here.  I am truly terrified about the idea of my little angel, getting her period and all the other complications of puberty, and not be able to understand what is happening to her.  

Hope this can help others facing the same worries.
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Hi,

My daughter is 8.5 yrs. and 73 lbs.  She already have under arm hair and her breast buds also developing.  I don't want her to have her period before 12/13 yrs. of age.
What can I do to slow down her Puberty.  

Is there any natural way to cleanse her body from all the unnecessary artificial hormones?  Is there any food/herbs that works?  Or which activities for how long helps?

Is it too late?  I am really worried, please help.

Thanks,

peeka.
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310293_tn?1274743373
She has normal start of adrenarche which is the pubic hair and body odor that can start as early as age 6! and may have normal just a little early breast buds, but I would start with her pediatrician, let them examine her and decide if a subspecialist needs to see her, often an xray of the hand is helpful as well as certain labs.
No natural way to stop early tempo of puberty, she weighs normal weight, so obesity is not a driver(good job), there are probably some strong genetic factors. It is not too late, I do not stop puberty after age 10 but others may differ in opinion. See your pediatrician first and go from there.
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Hi,
I can truly understand you worry. My daughter (7) first started displaying pubic hair when she was 5 and gained a lot of weight. She is now 40kgs, too heavy still. I didn't worry about the little bit of pubic hair becaue you caould hardly notice it - more like fluff. But just the other day when she was in the bath I noticed a lot of dark pubic hair and I panicked. I felt so sorry for her.
So, I have booked an appointment with a paed. endocroologist and I just hope they can get her in quickly because I don't want her to get her period...poor thing.
At school there has been a bit of teasing about her weight, no-one wants to piggy-back her! But I am dredding when they start swimming lessons and she has to get undressed in front of the other girls and someone notices.
At this stage, my daughter is unaware of the pubic hair ( I think becuase her chubby belly, she cant see it) and I have decided not to say anything until she asks me. Is this the right way to go? My reasons for not explaining anything is because I just want her to be a kid for as long as she can without having to worry about her body...there is plenty of years ahead to do that.
Can anyone tell me if this is the right way to go or should I tell her everything?

Kristin
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