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Central Precocious Puberty

CPP


Presentation

  • Case presentation. We present the case of a 15-month-old Asian male baby who presented with precocious puberty associated with hepatoblastoma.[mdanderson.elsevierpure.com]
  • Extensive imaging of the CNS for patients presenting with CPP is recommended.[thejns.org]
  • We present here a rare case of a 7-month-old infant girl with CPP and HH who was successfully treated with depot gonadotropin-releasing hormone (GnRH) analogue is presented.[ncbi.nlm.nih.gov]
Precocious Puberty
  • Two types of precocious puberty include the following: Gonadotropin-dependent precocious puberty.[stanfordchildrens.org]
  • Central precocious puberty in these children might follow extensive sex steroid exposure due to the peripheral precocious puberty induced by the activating mutation of the Gs protein gene.[ncbi.nlm.nih.gov]
  • E-mail: jaydeepsskm@gmail.com The term ‘Precocious puberty’ refers to the appearance of pubertal signs at an earlier age than established standard. Precocious puberty may be central or peripheral.[jcdr.net]
  • Treatment for precocious puberty depends on the cause. However, in some cases, there is no identifiable cause for precocious puberty.[mayoclinic.org]
Accelerated Growth
  • Abstract The 22q13 deletion syndrome or Phelan-McDermid syndrome is a neurodevelopmental disorder associated with developmental delay, hypotonia, delayed or absent speech, autistic-like behavior, normal to accelerated growth and dysmorphic faces.[ncbi.nlm.nih.gov]
  • […] of 9: Penile enlargement Testicular development Increased muscle development Voice change Growth of body hair Accelerated growth There are two types of precocious puberty: Central precocious puberty (CPP).[rileychildrens.org]
  • Precocious puberty Puberty is a complex biological process involving sexual maturation and accelerated growth. These processes normally initiate when pulsatile secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus begins.[imprinting-disorders.eu]
  • Early puberty accelerates growth. These children may initially be considerably taller than their peers. Because bone maturation is also accelerated, growth may be completed at an unusually early age, resulting in short stature.[emedicine.medscape.com]
Cushingoid
  • No cushingoid stigmata, mucocutaneous hyperpigmentation, café au lait macules, bony deformities or palpable abdominal lump were noted on clinical examination.[casereports.bmj.com]
Poor Feeding
  • Abstract Prader-Willi syndrome (PWS) is characterized by infantile lethargy and hypotonia causing poor feeding and failure to thrive, childhood obesity, short stature, and hypogonadism.[ncbi.nlm.nih.gov]
Diarrhea
  • There was history of frequent episodes of ill health withcough, fever, diarrhea and off and on vomiting.[sciedupress.com]
  • Other less frequent side effects include diarrhea, edema, fatigue, hypertension, constipation, pain, pneumonitis, as well as asymptomatic CPK elevation.[mdpi.com]
Hepatic Mass
  • Case presentation A 15-month-old Asian male baby presented to our center with precocious puberty and a hepatic mass. He was a product of cesarean section at 37 weeks of gestation.[cyberleninka.org]
Acneiform Eruption
  • They denied any history of acneiform eruptions, malodorous secretions, deepening of voice, muscular prominence or rapid height and weight gain in the child.[casereports.bmj.com]
Neck Swelling
  • There was no clitoral enlargement, neck swelling, pigmented skin marks, bone pain/fractures. Parents could not comment on any recent height gain. She had no significant medical illness or radiation exposure in the past.[ijem.in]
Lethargy
  • Abstract Prader-Willi syndrome (PWS) is characterized by infantile lethargy and hypotonia causing poor feeding and failure to thrive, childhood obesity, short stature, and hypogonadism.[ncbi.nlm.nih.gov]
Uterine Hemorrhage
  • hemorrhage, GnRh analog Abstract Introduction: Ovarian cysts are rare in prepubertal girls.[revistas.rcaap.pt]
Delayed Menarche
  • Histrelin implants have shown the greatest efficacy in delaying menarche by at least one year and increasing adult height by up to 7cm from predicted height.[digitalcommons.butler.edu]
Painful Erection
  • The clinical characteristics include rapidly somatic growth spurt, pubic and axillar hair, facial acne, painful erections, penis enlargement and deep voice. 12 ‒14 In the blood samples an elevated level of androgens, primarily testosterone, and normal[medcraveonline.com]
Imperforate Hymen
  • Imaging also revealed imperforate hymen, vaginal atresia, and mucocolpos.[ncbi.nlm.nih.gov]

Workup

  • Laboratory workup revealed Serum Sodium 138 mmol/L (Ref Values: 135-145), Serum Potassium 4.1 mmol/L (Ref Values: 3.5-5.0), Serum Chloride 101 mmol/L (Ref Values: 97-106).[sciedupress.com]
  • When should you start a workup? What should you order and when do you refer to endocrinology? We discuss these things and more with our pediatric endocrine consultant.[hippoed.com]
  • Subsequent laboratory workup demonstrated highly elevated hormone levels: LH 1.38 mIU/ml (normal 0.7), and testosterone 164 ng/dl (normal 9.0). Additionally, bone age was advanced, at 11 years.[thejns.org]
  • Footnotes Contributors: PKS and KSGS contributed to the clinical diagnosis, initial laboratory workup and treatment.[ncbi.nlm.nih.gov]
Thrombocytosis
  • Paraneoplastic features of hepatoblastoma are not uncommon at presentation and include thrombocytosis and increased alkaline phosphatase [ 2 ]. Occasionally, isosexual precocious puberty was reported in boys with hepatoblastoma [ 1, 3 – 15 ].[jmedicalcasereports.biomedcentral.com]
  • Paraneoplastic features of hepatoblastoma are not uncommon at presentation and include thrombocytosis and increased alkaline phosphatase [2]. Occasionally, isosexual precocious puberty was reported in boys with hepatoblastoma [1,3-15].[cyberleninka.org]

Treatment

  • Ht and HtSDS after treatment were positively correlated with the predicted Ht (PAH) before treatment and negatively correlated with the bone age/statural age ratio before treatment (p 0.05).[ncbi.nlm.nih.gov]

Prognosis

  • All previously reported cases in the literature are old and prognosis was grim. Case presentation. We present the case of a 15-month-old Asian male baby who presented with precocious puberty associated with hepatoblastoma.[mdanderson.elsevierpure.com]
  • The patient did not receive medical care for his precocious pubertal development, because of adequate height prognosis, and reached normal height for both his target height and Klinefelter patients.[ncbi.nlm.nih.gov]
  • We conclude that precocious puberty in Klinefelter syndrome may result in normal body proportion by inducing a major growth spurt of the trunk rather than in the limbs, and that adult height prognosis is not altered by precocious puberty.[onlinelibrary.wiley.com]
  • What is the prognosis of central precocious puberty? Similar to the treatment of central precocious puberty, the prognosis is related to the precise cause of the child's disease.[rxlist.com]

Etiology

  • Location Indianapolis, IN Subject Area Pharmacy, Health Sciences & Exercise Science Start Date 11-4-2014 8:30 AM End Date 11-4-2014 10:00 AM Description Background: Precocious puberty is a relatively rare disease with little documented information on etiology[digitalcommons.butler.edu]
  • In the present study, we aimed to evaluate the etiological factors in male CPP cases. METHODS: One hundred male CPP subjects, aged between 9 months and 10.5 years, were included.[ncbi.nlm.nih.gov]

Epidemiology

  • OBJECTIVES: Precocious puberty seems to be increasing but epidemiological data are scarce. Our objective was to improve the epidemiologic knowledge on this disease.[ncbi.nlm.nih.gov]
  • Summary Epidemiology The prevalence of CPP has been evaluated at approximately 1/ 500 girls and 1/ 2,000 boys in Denmark. Girls are more affected than boys, with an overall male to female ratio of at least 1:10.[orpha.net]
  • , Jesús Argente Localización: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría ( AEP ) , ISSN 1695-4033, ISSN-e 1696-4608, Vol. 74, Nº. 5, 2011 , pág. 336 Idioma: español Títulos paralelos: Central precocious puberty: epidemiology[dialnet.unirioja.es]
  • The epidemiology of CPP is somewhat nebulous, with a commonly cited prevalence range of 1 in 5000 to 1 in 10,000 children 7 . CPP is known to occur more frequently in girls than in boys and has different predominant causes for each sex.[endo.com]
Sex distribution
Age distribution

Pathophysiology

  • In addition, we discussed the recent findings on the pathophysiology of OPG development in NF1.[mdpi.com]
  • Reproductive endocrinology:Physiology, pathophysiology and clinical management. 4th ed. Philadelphia:WB Saunders;1999. p.153-190. P.214 掲載の参考文献 3) 伊藤裕ら:ナトリウム利尿ペプチド系の分子生物学と分子薬理. 日本臨牀 1993;51:140-148. 4) 伊藤裕ら:Na利尿ペプチドファミリーとジギタリス様因子の役割は. 矢崎義雄ら編.[molcom.jp]

Prevention

  • […] premature closure of the epiphyseal growth plates, thereby preventing short stature.[ncbi.nlm.nih.gov]

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