Resumo
Определение
Анамнез и осмотр
Ключевые диагностические факторы
- presença de fatores de risco
- meninos: testículos ≥4 mL
- meninas: desenvolvimento das mamas
- pelos pubianos/axilares
- menarca
- velocidade de crescimento aumentada
- alta estatura
Другие диагностические факторы
- manchas de cor café-com-leite
- sintomas de outros tipos de hiperfunção endócrina autônoma
- displasia fibrosa poliostótica
- neurofibromas, sardas axilares e cifoescoliose
- dismorfismo facial
- clitoromegalia
- anomalias oculares
- déficits motores
- tamanho craniano anormal
Факторы риска
- tumores cerebrais
- irradiação craniana
- Síndrome de McCune-Albright
- tumores gonadais
- hiperplasia adrenal congênita (HAC)
- história familiar positiva
- exposição a hormônios exógenos
- traumatismo cranioencefálico
- neurofibromatose do tipo 1
- Infecção prévia do sistema nervoso central
- hidrocefalia
- anomalias congênitas da hipófise
- adoção
- abuso sexual
Диагностические исследования
Исследования, которые показаны в первую очередь
- Estágios de Tanner
- medição do tamanho testicular
- avaliação da idade óssea
- hormônio folículo-estimulante (FSH) e hormônio luteinizante (LH) basais
- Teste de estimulação por hormônio liberador de gonadotrofina (GnRH)
- testosterona sérica
- estrogênio sérico
- ultrassonografia pélvica
Исследования, проведение которых нужно рассмотреть
- ressonância nuclear magnética (RNM) cranioencefálica
- TC cranioencefálica
- 17-hidroxiprogesterona
- perfil urinário de esteroides
- teste de estímulo com o hormônio adrenocorticotrópico (ACTH)
- TC ou RNM das adrenais
- ultrassonografia das adrenais
- cintilografia óssea/radiografia de esqueleto
- investigações de outros hormônios da hipófise
- teste genético
- testes da função tireoidiana
Неотложные исследования
- perfil de gonadotrofinas minutadas de repouso (overnight)
Алгоритм лечения
puberdade precoce central (PPC)
puberdade precoce independente de gonadotrofinas (PPIG)
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
Раскрытие информации
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
Раскрытие информации
PK declares that he has no competing interests.
Список литературы
Основные статьи
Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969 Jun;44(235):291-303.Полный текст Аннотация
Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970 Feb;45(239):13-23.Полный текст Аннотация
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.Полный текст Аннотация
Статьи, указанные как источники
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Отличия
- Telarca prematura
- Adrenarca prematura
- Hiperplasia adrenal congênita (HAC)
Больше ОтличияРекомендации
- GnRH analogue stimulation testing to investigate precocious puberty
- Use of gonadotropin-releasing hormone analogs in children: update by an international consortium
Больше Рекомендации
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