Precocious Puberty

Precocious Puberty

Brian Schmid DMD

Definition:
Early onset of puberty which results in normal development and growth. May be a variation of normal development or a disease-state secondary to abnormal endogenous hormone production or exogenous exposure.

Etiology:
Causes are variable and disparately supported. They include: endocrine disorders, familial associations, genital abnormalities, neurophysiologic conditions and hormone releasing tumors. Idiopathic central precocious puberty can be partial, complete or transient; it is often due to damage to the inhibitory system of the brain or a hypothalamic hamartoma releasing increased amounts of GnRH
Peripheral precocious puberty is caused by the presence of sex steroids from other sources such as gonadal/adrenal tumors, congenital hyperplasia etc.

Symptoms:
Early pubic, breast or genital development, induction of early bone maturation resulting in a reduced final adult height. Pubic hair or genital enlargement before 9.5 years, breast development in boys, pubic hair before 8 or breast development in girls with onset before 7 years, menstruation in girls before 10. Studies have shown that development in both sexes, particularly females is trending younger which has complicated the diagnostic criteria of precocious puberty.

Treatment:
It is often left untreated. Anastrazole, an aromatase inhibitor, can be used to interfere with the production of estrogens. Histrelin is a GnRH inhibitor.

Oral findings:
Often associated with McCune Albright Syndrome which can include polyostotic fibrous dysplasia and hypodontia. Also some crossover with Hyperpituitarism whose oral/dental findings include frontal bossing, prognathism, intradental separation, macroglossia, oligodontia and macrodontia.