Pubertad precoz
Summary
Определение
Анамнез и осмотр
Ключевые диагностические факторы
- presencia de factores de riesgo
- chicos: testículos ≥4 mL
- niñas: desarrollo mamario
- vello púbico/axilar
- menarquia
- velocidad de crecimiento aumentada
- estatura alta
Другие диагностические факторы
- manchas color café con leche
- síntomas de otra hiperfunción endocrina autónoma
- displasia fibrosa poliostótica
- neurofibromas, pecas axilares y cifoescoliosis
- dismorfia facial
- clitoromegalia
- alteraciones oculares
- déficits motores
- tamaño de cabeza anormal
Факторы риска
- tumores cerebrales
- irradiación craneal
- Síndrome de McCune-Albright
- tumores gonadales
- hiperplasia suprarrenal congénita (HSC)
- antecedentes familiares positivos
- exposición a hormonas exógenas
- lesión en la cabeza
- neurofibromatosis tipo 1
- infecciones previas de sistema nervioso central
- hidrocefalia
- anomalías hipofisarias congénitas
- adopción
- abuso sexual
Диагностические исследования
Исследования, которые показаны в первую очередь
- Etapas de Tanner
- medición del tamaño testicular
- evaluación de edad ósea
- hormona foliculoestimulante (FSH) basal y hormona luteinizante (LH)
- prueba de estimulación de la hormona liberadora de gonadotrofina (GnRH)
- testosterona en suero
- estrógenos séricos
- ultrasonido de pelvis
Исследования, проведение которых нужно рассмотреть
- imagen por resonancia magnética (IRM) cerebral
- tomografía computarizada (TC) cerebral
- 17-hidroxiprogesterona
- perfil de esteroides en orina
- prueba de estimulación con hormona adrenocorticotrópica (ACTH).
- tomografía computarizada (TC) o imagen por resonancia magnética (IRM) de glándulas suprarrenales
- ultrasonido de glándulas suprarrenales
- gammagrafía ósea/examen del esqueleto
- otras investigaciones de hormonas hipofisarias
- pruebas genéticas
- pruebas de función tiroidea
Неотложные исследования
- perfil de gonadotropinas durante la noche
Алгоритм лечения
pubertad precoz central (PPC)
pubertad precoz gonadotropina-independiente (PPGI)
Составители
Авторы
Talat Mushtaq, BSc, MBCHB, MRCPCH, MD
Paediatric Endocrinology Consultant
Leeds Teaching Hospitals NHS Trust
Leeds
UK
Раскрытие информации
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
Раскрытие информации
SH has received speaking honoraria from Sandoz and Novo Nordisk.
Выражение благодарностей
Dr Talat Mushtaq and Dr Sasha Howard would like to gratefully acknowledge Dr Ameeta Mehta and Professor Peter Hindmarsh, previous contributors to this topic.
Раскрытие информации
AM and PH are authors of several references cited within this topic.
Рецензенты
Malcolm Donaldson, MD, FRCP, FRCPCH, DCH
Senior Lecturer in Child Health
Department of Child Health
Royal Hospital for Sick Children
Glasgow
UK
Disclosures
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
Disclosures
PK declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969 Jun;44(235):291-303.Full text Abstract
Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970 Feb;45(239):13-23.Full text Abstract
Bangalore Krishna K, Fuqua JS, Rogol AD, et al. Use of gonadotropin-releasing hormone analogs in children: update by an International Consortium. Horm Res Paediatr. 2019;91(6):357-72.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Telarquia prematura
- Adrenarquia prematura
- Hiperplasia suprarrenal congénita (HSC)
More DifferentialsGuidelines
- GnRH analogue stimulation testing to investigate precocious puberty
- Use of gonadotropin-releasing hormone analogs in children: update by an international consortium
More Guidelines
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