Central precocious puberty: From genetics to treatment

Abstract

Central precocious puberty (CPP) results from early activation of the hypothalamic - pituitary -gonadal (HPG) axis and follows the same sequence as normal puberty. While many factors involved in pubertal initiation remain poorly understood, the kisspeptin system is known to play a key role. Currently, mutations in the kisspeptin system, MKRN3, and DLK1 have been identified in sporadic and familial cases of CPP. The diagnosis is based on physical exam findings indicating advancing puberty and on laboratory tests confirming central HPG axis activation. GnRH analogs are the mainstay of treatment and are used with the goal of height preservation. Newer extended release formulations continue to be developed. Currently there is no evidence of long-term complications associated with treatment. However, many areas remain to be explored such as targeted therapies and aspects of clinical management. Further investigation into psychological effects and additional data regarding long-term outcomes, particularly in males, is needed.

Basal serum luteinising hormone cut‐off, and its utility and cost‐effectiveness for aiding the diagnosis of the onset of puberty in girls with early stages of breast development

“…However, basal LH of 0.3 IU/L has been proposed and widely adopted as the cut-off for diagnosing CPP in previous studies. 1,6,18,19 Basal LH levels of 0.3 IU/L or greater were also associated with peak LH levels of 8 IU/L or greater and were observed in normal girls with Tanner stages IV and V breasts. 6,18 Therefore, diagnostic accuracy of these 2 basal LH cut-offs was compared.…”

“…Our study demonstrated that basal LH level of 0.2 IU/L represented 95th percentile of PT girls with Tanner stage II breasts. However, basal LH of 0.3 IU/L has been proposed and widely adopted as the cut‐off for diagnosing CPP in previous studies . Basal LH levels of 0.3 IU/L or greater were also associated with peak LH levels of 8 IU/L or greater and were observed in normal girls with Tanner stages IV and V breasts .…”

Adipokines: A gear shift in puberty

“…Both adrenarche and gonadarche are involved in the development of pubic hair . During gonadarche (Figure ), the hypothalamic‐pituitary‐gonadal (HPG) axis is activated, and several hormones have been identified to participate in the activation of the HPG axis including kisspeptin, neurokinin B, dynorphin, leptin, and ghrelin . Kisspeptin, neurokinin B, and dynorphin are released by specialized neurons, the KNDy neurons in the hypothalamus .…”

The Therapeutic Effect of Shugan Xiehuo Formula in Female Rat Model with Central Precocious Puberty

“…CPP is also caused by the early activation of the HPG axis, which results in the early development of uterus, ovary and early appearance of the corpus luteum. This process eventually causes the occurrence of CPP [2,11]. CPP seriously affects the physical development and mental health of children, but also increases the risk of metabolic diseases related to CPP [12].…”

“…Central precocious puberty (CPP) is caused by premature activation of the hypothalamic-pituitary-gonad (HPG) axis, which ultimately leads to the premature development of secondary sexual characteristics in children [1][2][3]. According to report, 1 out of every 5000 to 10,000 children develops CPP, and in general, the incidence of CPP in girls is much higher than that in boys [4].…”