Central Precocious Puberty (CPP)

What Is Central Precocious Puberty (CPP)?

It may seem like kids are growing up faster these days. But central precocious puberty (CPP) is a rare condition. It happens when the body matures sooner -- perhaps years earlier -- than expected.

Puberty usually starts around age 7 1/2 in girls and around age 9 in boys. For some children, such as those who are African-American or Hispanic, normal puberty may happen as early as age 6 in girls and age 8 in boys. But with CPP, signs of puberty, such as budding breasts and body hair, show up much sooner than parents might anticipate. It's more common for girls.

When it does happen in boys, there's a good chance there's an underlying, potentially serious medical cause that needs to be treated. This is usually not the case for girls.

Puberty is a big change, even when it happens on schedule. Early puberty can also cause problems with bone growth. Talk with your child's doctor about what's happening. If it's too soon, you can slow or even reverse the changes in their body.

Causes

The brain releases a hormone called gonadotropin-releasing hormone. Your doctor may call it GnRH. It tells the pituitary gland to release hormones called gonadotropins. They tell the sex organs to make other hormones that start sexual development.

In central precocious puberty, the brain releases GnRH at a younger-than-normal age and starts the process. Most of the time, doctors can't pinpoint an exact cause for girls, but researchers have linked childhood obesity to early periods.

Boys are more likely to have a specific trigger.

Other causes include:

  • A family history of CPP
  • A rare gene problem
  • A noncancerous tumor in the brain or pituitary gland
  • A brain injury
  • An infection in the brain, like meningitis
  • Radiation or chemotherapy for cancer treatment

Symptoms

The signs of CPP are the changes you'd expect to see in a maturing preteen or teen.

  • Hair in underarms and on private parts, and, for boys, on the face
  • Acne
  • Adult body odor
  • Sexual development like breast buds, or testicle growth
  • Emotional changes
  • Mood swings

Sometimes, kids can have hair appear in their private area and under the arm, but it doesn't mean they are in true puberty.

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Getting a Diagnosis

Your child's doctor will likely ask you questions before doing an exam or tests.

  • What physical changes have you seen in your child?
  • Has their behavior changed recently?
  • When did you first notice this? How long has this change been there?
  • Is there history of early puberty in your family?

If the symptoms aren't severe, it can be hard to tell if it's CPP. Your doctor may want your child to see a doctor who focuses on children's hormones and growth, called a pediatric endocrinologist. He'll look for signs of puberty, but he may also check:

  • Hormone levels
  • Bone age

Blood tests check levels of hormones.

X-rays help find out if your child's bones are maturing too early.

MRI or CT scans can rule out a tumor. These tests scan and make pictures of the inside of the body and brain.

For an older child, early development might be normal.

Questions for Your Doctor

  • What caused my child's symptoms?
  • Is there a way to slow down their development?
  • Do we need to treat this?
  • Could treating it cause other problems?
  • What happens after treatment stops?
  • What happens if we don't do anything?
  • What's the best way to explain CPP to my child?
  • Will my child be OK?

Treatment

If your doctor can find a specific cause, he'll treat that.

In some cases, doctors can use a drug to block sex hormones and prevent further development. A man-made version of GnRH stops the pituitary gland from sending out gonadotropins.

The doctor can give your child a shot once a month or every 3 months, or he could put a small implant under the skin of your child's upper arm, which works for a year. Where they get the shot or implant may hurt a bit, or their skin might get irritated around that spot, but there don't seem to be any long-term side effects.

You'll probably want to keep up the treatment until your child gets old enough to let puberty continue -- around age 11 for girls and 12 for boys.

Most doctors treat a child younger than 7 years old. When you're thinking about whether to treat CPP in an older child, you'll want to think about:

  • Your child's age
  • How slow or fast they're developing
  • How your child has been reacting
  • The chance of early menstruation
  • Concerns about their height as an adult

Talk these things over with your child's doctor before you make any decisions.

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Taking Care of Your Child

Most kids want to fit in with their peers. Developing early could make your child feel self-conscious. Other people may expect more maturity because they think your kid is older than he or she is.

These challenges plus the emotional changes from extra hormones can be a lot for them to deal with. Check in with the teachers and counselors at school, and keep an eye on your child's grades. Pay attention to their interest in things and being around friends and classmates.

How can you help? Explain what's happening in simple terms. Keep the lines of communication open.

  • Encourage your child to talk freely about her feelings.
  • Treat your kid appropriately for her age.
  • Watch out for teasing.
  • Do what you can to boost her self-esteem. Try to focus your praise on academics or activities, rather than appearance.

What to Expect

An early growth spurt can make your child taller than their friends at first, but their bones may stop growing earlier, too. Without treatment, your child may end up shorter than they could have been.

With treatment, they're more likely to reach their full adult height. Within a year, their growth should slow to a normal rate. Their sexual development will stall and may even reverse. For example, a girl's breasts and a boy's penis and testicles could get smaller. Your child should start acting like other kids their age, too.

Studies show children who are treated with GnRH have normal bone density. The treatment shouldn't affect them having kids of their own later, either.

Getting Support

You can connect with other families whose kids are dealing with CPP. The MAGIC Foundation offers information and support for many conditions, including central precocious puberty.

WebMD Medical Reference Reviewed by Roy Benaroch, MD on March 16, 2016

Sources

SOURCES:

Berberoglu, M. Journal of Clinical Research in Pediatric Endocrinology, June 2009.

Boston Children's Hospital: "Precocious (Early) Puberty."

KidsHealth: "Precocious Puberty."

UpToDate: "Treatment of precocious puberty."

Hindmarsh, P. "Gonadotrophin Releasing Hormones Analogues Usage in the Management of Precocious Puberty," University College London Hospitals, June 2003.

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