Precocious puberty in males
Precocious puberty in males: Excerpt from Professional Guide to Diseases (Eighth Edition)
In precocious puberty, boys begin to mature sexually before age 10. This disorder can occur as true precocious puberty, which is most common, with early maturation of the hypothalamic-pituitary-gonadal axis, development of secondary sex characteristics, gonadal development, and spermatogenesis, or as pseudoprecocious puberty, with development of secondary sex characteristics without gonadal development. Boys with true precocious puberty reportedly have fathered children as early as age 7.
In most boys with precocious puberty, sexual characteristics develop in essentially normal sequence; these children function normally when they reach adulthood.
Causes
True precocious puberty may be idiopathic (constitutional) or cerebral (neurogenic). In some patients, idiopathic precocity may be genetically transmitted as a dominant trait. Cerebral precocity results from pituitary or hypothalamic intracranial lesions that cause excessive secretion of gonadotropin.
Pseudoprecocious puberty may result from testicular tumors (hyperplasia, adenoma, or carcinoma) or from congenital adrenogenital syndrome. Testicular tumors produce excessive testosterone levels; adrenogenital syndrome produces high levels of adrenocortical steroids.
Signs and symptoms
All boys with precocious puberty experience early bone development, causing an initial growth spurt, early muscle development, and premature closure of the epiphyses, which results in stunted adult stature. Other features are adult hair pattern, penile growth, and bilateral enlarged testes. Symptoms of precocity due to cerebral lesions include nausea, vomiting, headache, vision disturbances, and internal hydrocephalus.
In pseudoprecocity caused by testicular tumors, adult hair patterns and acne develop. A discrepancy in testis size also occurs; the enlarged testis may be hard or may contain a palpable, isolated nodule. Adrenogenital syndrome produces adult skin tone, excessive hair (including beard), and deepened voice. A boy with this syndrome appears stocky and muscular; his penis, scrotal sac, and prostate are enlarged (but not the testes).
Diagnosis
Assessing the cause of precocious puberty requires a complete physical examination. A detailed patient history can help evaluate the patient’s recent growth pattern, behavior changes, a family history of precocious puberty, or ingestion of hormones.
In true precocity, laboratory results include the following:
❑ Serum levels of luteinizing and follicle-stimulating hormones and corticotropin are elevated.
❑ Plasma tests for testosterone demonstrate elevated levels (equal to those of an adult male).
❑ Evaluation of ejaculate reveals the presence of live spermatozoa.
❑ Brain scan, skull X-rays, and EEG can detect possible central nervous system tumors. Abdominal scans can detect testicular tumors.
A child with an initial diagnosis of idiopathic precocious puberty should be reassessed regularly for possible tumors.
In pseudoprecocity, chromosomal karyotype analysis demonstrates an abnormal pattern of autosomes and sex chromosomes. Elevated levels of 24-hour urinary 17-ketosteroids and other steroids also indicate pseudoprecocity.
Treatment
Boys with idiopathic precocious puberty generally require no medical treatment and suffer no physical complications in adulthood. Supportive psychological counseling is the most important therapy.
When precocious puberty is caused by tumors, the outlook is less encouraging. Brain tumors necessitate neurosurgery but may resist treatment and prove fatal. Testicular tumors may be treated by removing the affected testis (orchiectomy). Malignant tumors require chemotherapy and lymphatic radiation therapy. The prognosis is generally good, depending on tumor histology and degree of differentiation.
Adrenogenital syndrome that causes precocious puberty may respond to lifelong therapy with maintenance doses of glucocorticoids (cortisol) to inhibit corticotropin production.
Special considerations
❑ Emphasize to parents that the child’s social and emotional development should remain consistent with his chronological age, not with his physical development. Advise parents not to place unrealistic demands on him.
❑ Reassure the child that, although his body is changing more rapidly than those of other boys, eventually they will experience the same changes. Help him feel less self-conscious about his changing body. Suggest clothing that de-emphasizes sexual development.
❑ Provide sex education for the child with true precocity.
❑ If the child must take glucocorticoids for the rest of his life, explain the medication’s adverse effects (cushingoid symptoms) to the family.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
More About Menarche
More Medical Textbooks Online about Menarche
Review other book chapters online related to Menarche:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Precocious Puberty (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
