Puberdade precoce
Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- meninos: testículos ≥4 mL
- meninas: desenvolvimento das mamas
- pelos pubianos/axilares
- menarca
- velocidade de crescimento aumentada
- alta estatura
Outros fatores diagnósticos
- 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
Fatores de risco
- 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- 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
Investigações a serem consideradas
- 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
Novos exames
- perfil de gonadotrofinas minutadas de repouso (overnight)
Algoritmo de tratamento
puberdade precoce central (PPC)
puberdade precoce independente de gonadotrofinas (PPIG)
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
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
- Telarca prematura
- Adrenarca prematura
- Hiperplasia adrenal congênita (HAC)
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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