Childhood precocious puberty is a disease of abnormal growth and development, which is mainly manifested by the appearance of the secondary sexual characteristics of adolescence in a large extent ahead of time, which seriously violates the normal development cycle of children and affects their mental health and physical and mental development.
Recently, the pediatric neurosurgery team of Nanfang Hospital treated 3 children with intracranial tumors whose main clinical manifestation was precocious puberty. Professor Fang Luxiong, chief physician of neurosurgery department of Nanfang Hospital and professor of pediatric neurosurgery department, introduced that recent clinical studies have shown that precocious puberty can be the first symptom of some children's tumors, especially the younger the age of onset, the more likely precocious puberty caused by organic diseases.
It is reported that the causes of precocious puberty in children are diverse. According to whether there is the activation of sexual gland axis, it can be divided into central precocious puberty and peripheral precocious puberty. Central precocious puberty is true precocious puberty, also known as gonadotropin releasing hormone dependent precocious puberty. Peripheral precocious puberty is also called pseudo precocious puberty, also known as gonadotropin releasing hormone dependent precocious puberty.
Fang Luxiong pointed out that central precocious puberty is a common pediatric endocrine disease, which refers to the rapid development of internal and external reproductive organs and the presentation of secondary sexual characteristics before the age of 8 in girls and 9 in boys due to the early activation of hypothalamus pituitary gonad axis function. The incidence of central precocious puberty is about 1/5000-1/10000, which is mostly seen in girls. Among the central precocious puberty girls who have sexual development before the age of 6, the proportion of central nervous system abnormalities is about 20%, and the younger the age, the greater the possibility of imaging abnormalities. Although the incidence of precocious puberty in boys is relatively low, about 50% of the children have central nervous system tumors.
Fang Luxiong said that central precocious puberty can lead to premature sexual development and early menarche of girls; The bone matures quickly, the bone age exceeds the actual age and the epiphysis closes early, which affects the final height of the child; The second sexual characteristic develops prematurely and matures sexually, resulting in corresponding psychological problems or social behavior abnormalities.
Common tumors that cause central precocious puberty include hypothalamic hamartoma, germ cell tumor, etc. "Other lesions in the sellar region and hypothalamus, such as craniopharyngioma and optic chiasmatic glioma, will mostly lead to growth retardation, but some children also show precocious puberty." Fang Luxiong introduced that the reason why hypothalamic lesions lead to precocious puberty is that the tumor in this part stimulates the hypothalamus, leading to the early start of the pituitary gonadal axis; On the other hand, due to the compression of the tumor on the hypothalamus, the inhibition of the hypothalamus on the pituitary gonad axis is relieved, and the amount of follicle stimulating hormone and luteinizing hormone secreted by the pituitary is constantly increasing, leading to the premature development and sexual maturity of the second sexual characteristic.
As far as intracranial germ cell tumors are concerned, Fang Luxiong said that the study found that the increase of human chorionic gonadotropin is the root cause of precocious puberty in children. Human chorionic gonadotropin is a glycoprotein hormone secreted by trophoblastic cells, which is highly similar to luteinizing hormone in structure. The concentration of human chorionic gonadotropin in serum increases, stimulates the testosterone receptor, and promotes the secretion of testosterone by testicular interstitial cells. The testosterone level is positively correlated with the level of human chorionic gonadotropin, thus promoting the penis thickening Growth, early appearance of the second sexual characteristic, showing precocious puberty.
Fang Luxiong pointed out that epidemiological studies show that early development is more likely to cause psychological and behavioral problems such as functional performance, depressive symptoms and sexual contact. Therefore, parents need to pay enough attention, be alert to the early development of children's secondary sexual characteristics, and seek medical advice in a timely manner. The central precocious girls and all precocious boys who are less than 6 years old should have skull MRI examination. Guangzhou Daily (full media reporter Wu Ren, correspondent Li Xiaoshan, Song Ye)
