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Early puberty: how are the treatment and follow-up done?

Early puberty: how are the treatment and follow-up done?

Precocious puberty occurs when the child's body begins to develop signs typical of puberty but before the age considered normal. In most cases, this occurs when girls begin to show breast growth before age eight or when boys begin to have testicles enlarged before age 9.

Another condition associated with early puberty is that in stage, there is also an increase in the speed of growth and, when puberty starts very early, the child's final height may be impaired. In addition, there are psychological issues involved. "An eight or nine-year-old girl who has a woman's body feels completely different from her friends, and so do boys, who start to thicken their voices before everyone else and show up in their bodies," says the Hebiatra and pediatrician Andrea Hercowitz, of the Hospital Israelita Albert Einstein, in São Paulo. All of these factors end up interfering with the child's self-esteem, which is usually more unstable at this stage.

Some doubts are common after the diagnosis of early puberty:

How is puberty treated? talking to patient and his mother - Photo: Getty Images

The treatment of precocious puberty depends on its cause. When it is GnRH-dependent (called central because it is caused by changes in the central nervous system), the treatment is given by the use of hormones to block the hormonal axis that causes its anticipation. The activation of this axis occurs when the pituitary, a gland located in the brain, begins to release hormones that stimulate the gonads (ovary and testis) to work, releasing the sex hormones (estrogen and testosterone), which will begin to act in the body causing the puberty.

Currently, the treatment of central precocious puberty is performed with GnRH analogues, a synthetic hormone that blocks the work of the pituitary, leaving the axis inactive. However, it is not recommended for all age groups and who should determine its use is the doctor who follows the case. "The drug is indicated until a certain age and determined by the complete clinical evaluation, prediction of final height, bone age and the child's pubertal moment at the start of treatment," says endocrinologist and pediatrician Felipe Monti Lora, a member of the Center for Excellence in

When early puberty is not dependent on GnRH, its causes may be organic and the treatment may be surgical or radio / chemotherapeutic.

However, when early puberty is caused by some other factor, such as tumors in the pituitary gland or some modification in the gonads, this problem should be given priority treatment before initiating therapy to block puberty. In addition, even if early puberty does not cause, late diagnosis may make the treatment ineffective. "After menstruation in girls, for example, it is more difficult to block the axis and will be evaluated by the doctor the effectiveness of starting the treatment or not," says Lora.

How is the follow up?

In most cases, precocious puberty occurs due to an unknown pituitary problem and the follow up varies according to the treatment defined by the specialist - who may or may not use medications to block puberty.

When choosing drug treatment, control appointments are required. "With treatment, the ideal is for the doctor to see the patient every six months to observe the response to the medication," explains the hebiatra and pediatrician Andrea Hercowitz.Now, when the attending physician believes it is no longer possible to block the onset of puberty, closer follow-up is needed.

How to know that the treatment is working?

X-ray of the wrist - Photo: Getty Images

When the child is treated, the results appear by slowing down the symptoms of puberty, that is, the growth rate slows down and the appearance of new pubic hair or the rest of the body no longer occurs. "In addition, it is normal for girls to have a small amount of vaginal bleeding as soon as they begin treatment," explains the pediatric endocrinologist Felipe Monti Lora.

Many follow-up exams are often needed to detect recovery, especially if there was a deceleration in the development of the child's bone age. This is assessed by an X-ray of the hands and wrists. In it, the size of the bones is measured according to some medical standards, to determine how is the evolution of bone growth.


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