小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 男童：睾丸≥4 mL
- 女性：乳房发育
- 阴毛和（或）腋毛
- 月经初潮
- 生长加速
- 身材高大
其他诊断因素
- 咖啡牛奶斑
- 其他自主内分泌功能亢进的症状
- 多骨性纤维异常增生症
- 神经纤维瘤，腋窝雀斑，脊柱后侧凸
- 面部畸形
- 阴蒂增大
- 眼部异常
- 运动受限
- 头颅大小异常
危险因素
- 脑肿瘤
- 头颅照射
- McCune-Albright 综合征
- 性腺肿瘤
- 先天性肾上腺皮质增生症（CAH）
- 阳性家族史
- 暴露于外源性激素
- 头部损伤
- 神经纤维瘤病 1 型
- 既往中枢神经系统 (CNS) 感染
- 脑积水
- 先天性垂体异常
- 收养
- 性虐待
诊断性检查
首要检查
- Tanner 分期
- 测量睾丸尺寸
- 骨龄评估
- 基底卵泡刺激素（FSH）和黄体生成素（LH）
- 促性腺激素释放激素（GnRH）刺激试验
- 血清睾酮
- 血清雌激素
- 盆腔超声检查
需考虑的检查
- 颅脑 MRI 扫描
- 头颅 CT
- 17-羟孕酮
- 尿类固醇测定
- 促肾上腺皮质激素 (ACTH) 刺激试验
- 肾上腺CT或MRI扫描
- 肾上腺超声
- 骨扫描和（或）骨骼检查
- 其他垂体激素检查
- 基因检测
- 甲状腺功能检测
新兴检查
- 过夜促性腺激素检查
治疗流程
中枢性性早熟（CPP）
非促性腺激素依赖性性早熟（GIPP）
撰稿人
作者
Talat Mushtaq, BSc, MBCHB, MRCPCH, MD
Paediatric Endocrinology Consultant
Leeds Teaching Hospitals NHS Trust
Leeds
UK
利益声明
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
利益声明
SH has received speaking honoraria from Sandoz and Novo Nordisk.
鸣谢
Dr Talat Mushtaq and Dr Sasha Howard would like to gratefully acknowledge Dr Ameeta Mehta and Professor Peter Hindmarsh, previous contributors to this topic.
利益声明
AM and PH are authors of several references cited within this topic.
同行评议者
Malcolm Donaldson, MD, FRCP, FRCPCH, DCH
Senior Lecturer in Child Health
Department of Child Health
Royal Hospital for Sick Children
Glasgow
UK
利益声明
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
利益声明
PK declares that he has no competing interests.
鉴别诊断
- 乳房早发育
- 肾上腺功能早现
- 先天性肾上腺皮质增生症
更多 鉴别诊断指南
- 评估性早熟的 GnRH 类似物刺激试验
- 促性腺激素释放激素类似物在儿童中的应用：国际联盟更新
更多 指南
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