Central Precocious Puberty (CPP)

What is central precocious puberty (CPP)?

Puberty is the time when boys and girls become sexually mature. Puberty usually starts between 8 and 13 years of age for girls and 9 and 14 years of age for boys. It causes different types of changes in the body for each gender. Rapid growth of bones and muscles, changes in body shape and size, and becoming able to reproduce are some of the changes involved in puberty. Other signs of puberty include developing pubic and underarm hair, underarm odor, increase in height, and acne. Voice deepening and growth of the penis and testes happens in boys, while girls start their menstrual period and experience breast development. 
 
Central precocious puberty (CPP) causes early puberty in girls and boys. Puberty is considered precocious puberty when it starts before age 8 in girls and before age 9 in boys. These children may be much taller than others their age who don’t have this condition, but usually stop growing early and may be a lot shorter than others in their family as adults if the condition is not treated. They sexually develop much earlier than their peers and can experience psychological and/or behavioral problems due to the emotional impact this may have. 
 
The difference between central and peripheral precocious puberty (the other type of precocious puberty) is that peripheral precocious puberty is caused by estrogen or testosterone in the child’s body while in central precocious puberty the cause is unclear. It occurs when the brain releases some puberty-triggering hormones too early. The word “central” is used in the name because the brain is part of the central nervous system.  
 
 
Risk factors
 
  • Gender: Precocious puberty is more common in girls 
  • Obesity: Severely overweight children are at higher risk for CPP 
  • Race/ethnicity: African Americans have a higher risk 
  • Exposure to sex hormones: Estrogen or testosterone exposure from creams, ointments, or other substances can increase a child’s risk for developing central precocious puberty.
  • Radiation therapy of the central nervous system can increase a child’s risk of developing CPP
  • Injury to the brain or spinal cord
  • Other medical conditions: McCune-Albright syndrome and congenital adrenal hyperplasia are two conditions that may increase one’s risk for developing CPP because they cause an abnormal hormone production. In some rare cases, precocious puberty can be associated with hypothyroidism.
  • A brain defect that is present at birth such as hydrocephalous or a non-cancerous tumor
 
 
Diagnosis of central precocious puberty will most likely include a complete medical history and physical examination. The doctor will also review the medical history of the patient’s family. 
 
Other methods used to diagnose central precocious puberty include:
 
  • Blood tests to check hormone levels
  • X-rays of the hand and wrist can help the doctor figure out the child’s bone age - which can show if the bones are growing too fast. 
  • Gonadotropin-releasing hormone (Gn-RH) stimulation test is used to determine if one has central or peripheral precocious puberty. Gn-RH is a hormone found in the brain that stimulates the pituitary gland to release two more hormones that trigger the creation of sex hormones resulting in puberty. In this diagnostic test, GN-RH is administered and then blood samples are drawn. In children with precocious puberty the Gn-RH stimulation test will cause other hormone levels to rise, while in peripheral precocious puberty the levels will stay the same. 
  • Computerized tomography (CT) scan and/or magnetic resonance imaging (MRI) to detect any brain abnormalities or tumors in the hypothalamus and/or pituitary gland. 
  • Thyroid testing can be done to check one’s thyroid hormone levels and see if they potentially have hypothyroidism which is associated with central precocious puberty in rare cases.
  • Ultrasound of the pelvis and adrenal glands. 
 
 
Treatment
In cases of central precocious puberty where there is no underlying medical condition triggering it, medication is often prescribed. 
 
Possible methods of treatment for central precocious puberty include:
 
  • Gn-RH analogue therapy
  • Tumor removal (if a tumor is responsible for causing the condition)
  • Treatment of any underlying conditions that may be contributing to the development of precocious puberty
 
# CENTRAL PRECOCIOUS PUBERTY (CPP) BY THE NUMBERS #
  • CPP occurs in 1 out of every 5,000-10,000 children
  • CPP is more common in girls 
  • CPP is the most common type of precocious puberty 
 
about central precocious puberty (CPP)
 
 

Sources:
  • "Precocious puberty." Mayo Clinic. Mayo Foundation for Medical Education and Research, 11 Nov. 2016. Web. 05 Sep. 2017.
  • “What is Central Precocious Puberty (CPP)?” Abbvie. Lupron Depot-Ped (leuprolide acetate for depot suspension), n.d. Web. 05 Sep. 2017. 
  • “Puberty.” National Institutes of Health U.S. National Library of Medicine. MedlinePlus, n.d. Web. 05 Sep. 2017. 
  • “central precocious puberty.” National Institutes of Health U.S. National Library of Medicine. Genetics Home Reference, 05 Sep. 2017. Web. 05 Sep. 2017. 
  • “Precocious Puberty.” Johns Hopkins Medicine. Johns Hopkins Medicine Health Library, n.d. Web. 05 Sep. 2017. 
  • “Central Precocious Puberty (CPP).” WebMD, n.d. Web. 05 Sep. 2017. 

 

Not everyone experiences the changes of puberty the same. The way one grows and develops can be completely different from the way their peers develop. The Tanner stages outline a general guide on the development of secondary sex characteristics.
 
proper growth stages during puberty

 

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