Hi, this is Tom, and in this episode I'm going to be going through early puberty,

and you can find notes at zero to finals.com and in the zero to finals pediatrics book,

and you can find flashcards and questions at members.0.0 tofin0.com. So let's jump straight in.

Early puberty is defined as the onset of pubertal changes before the age of 8 in girls

and 9 in boys. Early puberty can result in a reduction in the final adult height due to premature fusion of the epiphyseal plates or the growth plates.

It also has a psychosocial impact, for example associated with early menstruation in girls.

Let's talk about the causes.

The causes of early puberty are split into two groups.

Gonadotropin-dependent precocious puberty, or central precocious puberty, and gonadotropin-independent precocious puberty, or peripheral precocious puberty. Genadotropin independent precocious puberty or peripheral precocious puberty.

Gannadotropin dependent precocious puberty involves early activation of the hypothalmic

pituitary gonadal axis. The hypothalamus starts producing gonadotropin releasing hormone, or GNRH, early.

GNRH stimulates the anterior pituitary gland to produce lutonizing hormone, or LH,

and follicle stimulating hormone, or FSAH, which stimulates the ovaries or the testes to start

producing the sex hormones, estrogen or testosterone. Causes of gonadotropin dependent, precocious

puberty include idiopathic, meaning no clear cause, and this is common, particularly in

girls, central nervous system pathology, for example tumours or radiotherapy, and genetic

mutations, for example the K-I-S-S-1 and M-K-R-N-3 mutations.

Gonadotropin independent precocious puberty occurs where there is an excess of steroid hormones

in the body that are not being controlled by the hypothalamic pituitary genital

axis.

Causes include exogenous sex steroid hormones. For example,

if somebody's using estrogen cream that was prescribed for their mother and having the estrogen

...