Adrenals

The word precocious refers to a child who exhibits exceptional maturity or skill at an unusually early age.  When used in a non-medical context, it could refer to a child that is extraordinarily talented in music, mathematics, athletics, or other cognitive areas.  Pediatricians use the term precocious puberty in reference to children who show hormonal manifestations and physical characteristics of puberty at an earlier age than normal.

How Early Is Too Early?

Puberty typically begins within the age range of 8 to 13 for females and between the age of 9 and 14 for boys.  A girl who shows the physical signs of puberty, such as breast development and pubic hair growth, before age 8 is said to have precocious puberty.  Boys who exhibit the physical signs of puberty before age 9 are said to have precocious puberty.  With the onset of early puberty, kids grow rapidly.  Children with untreated precocious puberty do not usually reach their genetic height.  Boys often grow no taller than 5 feet 2 inches and girls often grow to only 5 feet.

How Puberty Begins

A complex physiological system known as the hypothalamic-pituitary-gonadal axis (HPG) is responsible for initiating the onset of puberty. The hypothalamus gland releasesgonadotropin-releasing hormone (Gn-RH), which then triggers the pituitary gland to secreteluteinizing hormone (LH) and follicle stimulating hormone (FSH).  LH and FSH stimulate the sexual organs to produce estrogen in girls and testosterone in boys, causing the physical signs of puberty.  When the body initiates this system early, precocious puberty occurs.

Signs and Symptoms

Any signs of puberty in young children are cause for concern.  The physical signs are the same seen in a child undergoing puberty at a normal age.  Some of the signs of puberty for girls and boys are the same, but most are different.

Signs of Puberty in Girls

Breast development
Pubic hair development
Body odor
Menstruation
Rapid growth in height
Acne

Signs of Puberty in Boys

Enlargement of penis and testicles
Pubic hair development
Facial hair growth
Body odor
Acne
Deepening of voice
Rapid growth in height

Why Does Puberty Sometimes Start Early?

The cause of precocious puberty in children depends on the type that the pediatric endocrinologist determines they have.  Characteristics of two types of precocious puberty are as follows:

Gonadotropin-Dependent (Central Precocious Puberty) often has no clearly identifiable trigger.  The HPG axis begins too early and normal pubertal development begins in the young child.  There is usually no adjunct medical condition triggering the onset and no other identifiable cause.  Rarely, serious underlying causes are to blame:  brain or spinal tumor; infection of the central nervous system (CNS); injury to the CNS; radiation exposure; various genetic disorders that affect the endocrine system.

Gonadotropin-Independent (Peripheral Precocious Puberty) is caused by the presence of estrogen or testosterone in the child’s system that is not a result of early HPG axis initiation. Problems with the pituitary, adrenal glands, testicles, or ovaries are to blame for the untimely presence of estrogen or testosterone.

The presence of an estrogen- or testosterone-secreting tumor in the pituitary or adrenal glands can cause the condition in both boys and girls.  In both genders, exposure to outside sources of the hormones in creams and ointments may trigger early puberty as well as genetic disorders.

For girls, ovarian cysts or tumors may cause peripheral precocious puberty.  Boys may have a tumor in the sperm producing cells (germ cells) or Leydig Cells (cells that produce testosterone).  Rarely, boys have a gene mutation called familial gonadotropin-independent sexual precocity.

Prepare for a Visit to a Pediatric Endocrinologist

Once the pediatric doctor examines your child and determines that he may have precocious puberty, he will likely refer you to a pediatric endocrinologist.  Arrive prepared with the following: a list of your child’s symptoms; medications and supplements he currently takes; a record of family heights; a family medical history; and a copy of your child’s growth chart – all of which can be obtained from your child’s pediatric clinic.

Diagnosis

The pediatrician will review your family history and the other information you supplied.  After a physical exam, he will order blood tests to check the levels of various hormones.  An X-ray of your child’s hand and wrist will determine the bone age and whether he is growing too fast.  Once precocious puberty is confirmed, the physician must then determine which type your child has. To do this, he will inject Gn-RH into your child’s bloodstream and then take a blood sample.  With central precocious puberty, LH and FSH levels rise.  With peripheral precocious puberty, they remain the same. He will order additional tests specific to your child’s type of condition to confirm or exclude underlying medical conditions.

Treatment

The cause of the precocious puberty determines the treatment.  Children with central precocious puberty receive a treatment known as Gn-RH Analogue Therapy.  The child receives a monthly injection of a medication, such as leuprolide, that halts the HPG axis and consequently stops the pubertal development.  Once she reaches the normal age of puberty, treatment is stopped and puberty begins once again.

Those with peripheral precocious puberty will have the underlying cause of their condition removed.  If a hormone-secreting tumor is to blame, it will be surgically removed.  In either type of early puberty, if a genetic disorder is the cause, the child may need medications and therapy in addition to those regularly used.

Originally published here.

Adrenal insufficiency is a life-threatening condition. It affects about 1 in 100,000 people. It occurs in all age groups and agonize men and women equally. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and non-exposed parts of the body. Causes of the permanent form of the condition include Addison’s disease, congenital adrenal hyperplasia, complete surgical removal of the pituitary gland or the adrenal. Primary adrenal insufficiency, which can be acute or chronic, may be caused by the anatomic destruction of the gland. This destruction can have various causes, including tuberculosis (TB) or fungal infection , other diseases infiltrating the adrenal glands, and hemorrhage.

Primary insufficiency – rare 0.8 per 100,000; affects both sexes equally and can occur at any age. Secondary conditions are related to both long and short-term use of corticosteroids or megesterol acetate. Secondary adrenal insufficiency may be caused by hypopituitarism due to hypothalamic-pituitary disease, or it may result from suppression of the hypothalamic-pituitary axis by exogenous steroids or endogenous steroids. Secondary adrenocortical insufficiency is relatively common. Extensive therapeutic use of steroids has greatly contributed to increased incidence. Causes of adrenal insufficiency may include genetics , congenital weakness, nutritional imbalances, emotional or psychological stress, toxic substances , mental attitude, stimulants and mental attitude.

Symptoms of adrenal insufficiency is fatigue, decreased tolerance to cold, low stamina, apathy or depression, allergies, low blood pressure, low blood sugar level and poor circulation. Treatment of Addisons disease involves replacing, or substituting, the hormones that the adrenal glands are not making. Cortisol is replaced orally with hydrocortisone tablets. Aldosterone is replaced with oral doses of a mineralocorticoid, called fludrocortisone acetate, that are taken once a day. Fludrocortisone helps to maintain the right levels of salt and fluids in the body. Nutritional supplements to reduce stress and enhance adrenal activity. Detoxification procedures such as sauna therapy to help eliminate toxic metals. Lifestyle modification to reduce harmful stressors.

Adrenal insufficiency Treatment and Prevention Tips

1. Cortisol is replaced orally with hydrocortisone tablets.

2. Lifestyle modification to reduce harmful stressors.

3. Nutritional supplements to reduce stress and enhance adrenal activity.

4. Detoxify or de-infect something that needs to be removed from the body in order to heal.

5. Fludrocortisone may be withheld on the day of surgery

6. Androgen replacement is sometimes recommended for women with primary adrenal insufficiency.

Originally published here.