Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- boys: testes ≥4 mL
- girls: breast development
- pubic/axillary hair
- menarche
- increased growth velocity
- tall stature
Outros fatores diagnósticos
- café au lait spots
- symptoms of other autonomous endocrine hyperfunction
- polyostotic fibrous dysplasia
- neurofibromas, axillary freckling, and kyphoscoliosis
- facial dysmorphism
- clitoromegaly
- eye abnormalities
- motor deficits
- abnormal head size
Fatores de risco
- brain tumors
- cranial irradiation
- McCune-Albright syndrome
- gonadal tumors
- congenital adrenal hyperplasia (CAH)
- positive family history
- exposure to exogenous hormones
- head injury
- neurofibromatosis type 1
- previous central nervous system infections
- hydrocephalus
- congenital pituitary abnormalities
- adoption
- sexual abuse
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Tanner staging
- measurement of testicular size
- bone age assessment
- basal follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
- gonadotropin-releasing hormone (GnRH) stimulation test
- serum testosterone
- serum estrogen
- ultrasound pelvis
Investigações a serem consideradas
- MRI brain
- CT brain
- 17-hydroxyprogesterone
- urinary steroid profile
- adrenocorticotropic hormone (ACTH) stimulation test
- CT or MRI adrenals
- ultrasound adrenals
- bone scan/skeletal survey
- other pituitary hormone investigations
- genetic testing
- thyroid function tests
Novos exames
- overnight gonadotropin profile
Algoritmo de tratamento
central precocious puberty (CPP)
gonadotropin-independent precocious puberty (GIPP)
Colaboradores
Autores
Talat Mushtaq, BSc, MBCHB, MRCPCH, MD
Paediatric Endocrinology Consultant
Leeds Teaching Hospitals NHS Trust
Leeds
UK
Declarações
TM has received support from Novo Nordisk and Pfizer to attend overseas conferences. He has also received honoraria from Kyowa Kirin for lectures and educational events.
Sasha Howard, MBBS, MRCPCH, MSc, PhD
Senior Lecturer and Honorary Consultant in Paediatric Endocrinology
Queen Mary University of London
Barts Health NHS Trust
London
UK
Declarações
SH has received speaking honoraria from Sandoz and Novo Nordisk.
Agradecimentos
Dr Talat Mushtaq and Dr Sasha Howard would like to gratefully acknowledge Dr Ameeta Mehta and Professor Peter Hindmarsh, previous contributors to this topic.
Declarações
AM and PH are authors of several references cited within this topic.
Revisores
Malcolm Donaldson, MD, FRCP, FRCPCH, DCH
Senior Lecturer in Child Health
Department of Child Health
Royal Hospital for Sick Children
Glasgow
UK
Declarações
MD has received lecture fees and financial support from pharmaceutical companies (Pfizer, Novo Nordisk, Serono) that manufacture growth hormone and whose brands of growth hormone MD recommends. MD is also an author of articles cited in this topic.
Paul Kaplowitz, MD, PhD
Professor Emeritus
Division of Endocrinology
Children's National Hospital
Washington
DC
Declarações
PK declares that he has no competing interests.
Diagnósticos diferenciais
- Premature thelarche
- Premature adrenarche
- Congenital adrenal hyperplasia (CAH)
Mais Diagnósticos diferenciaisDiretrizes
- GnRH analogue stimulation testing to investigate precocious puberty
- Use of gonadotropin-releasing hormone analogs in children: update by an international consortium
Mais Diretrizes
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