Personally, I had never heard of the term “precocious puberty,” but I have observed teenage girls who behaved like adults, however, I never thought it could be a medical condition. Researching this topic was eye-opening and would like to dig deeper in the future. It is interesting that you meet someone who you think might be your age but later on come to realize that he or she is very young, and apparently, has a condition that needs treatment.Children enter puberty from age 13 through to 18 years. At the onset of puberty, they undergo hormonal changes, simultaneously being preoccupied with their body image. This period, also known as the adolescent stage, is where identity formation starts; that is, becoming more aware of themselves and forming an individuality that they seem fit for that phase of their lives.“Manifestations of sexual development before age nine for boys and age eight for girls have traditionally been considered “precocious development” (Hockenberry&Wilson, 2015). In addition to that, puberty is considered “precocious” when girls below eight years showed signs of early puberty. Boys, on the other hand also experienced precocious puberty if they showed signs of puberty generally before age nine.Precocious puberty has several consequences for affected children and their families. The impact can be both physical and psychological. Because of the potential for a rapid deterioration of the disorder, it is necessary to detect and diagnose early, in order to allow a judgement about the prospective course of the disease, in terms of rate of pubertal progression, statural growth, bone age progression, development of reproductive functions and psychosocial adjustment and well‐being. (Partsch et al, 2002). The hypothalamic-releasing factors normally stimulate secretion of the gonadotropic hormone from the anterior pituitary at the time of puberty. “In the male, interstitial cell–stimulating hormone stimulates Leydig cells of the testes to secrete testosterone. In the female, follicle-stimulating hormone and luteinizing hormone stimulate the ovarian follicles to secrete estrogens. This sequence of events is known as the Hypothalamic-pituitary-gonadal axis. If for some reason the cycle undergoes premature activation, the child displays evidence of advanced or precocious puberty.” Sex hormones can have an impact on bone growth, and premature exposure may cause short stature. (Hockenberry&Wilson, 2015). It is prevalent among White, Black and Hispanic girls who fall within the precocious puberty age bracket. However, White males, compared to their black or Hispanic counterparts, can have this condition delayed till almost age 10. Girls typically show signs such as breast development and growth of pubic hairs while boys manifest their pubertal development with the enlargement of the testicles, facial and pubic hair, deepening of the voice, among others. According to Nord, “The disorder has an incidence of 1 in 5-10,000 children with a female to male ratio of about 20:1 although this ratio is debated. Eighty to ninety percent of girls with true PP have idiopathic CPP whereas over 50% of boys have an identifiable etiology for true P precocious Puberty. (Nord, 2019)Much awareness must be drawn to this issue because children with precocious puberty may grow quickly at first and be tall, compared with their peers. But, because their bones mature more quickly than normal, they often stop growing earlier than usual, causing them to be shorter than an average adult. Also, girls and boys would have an increased risk of developing depression because of the difference in their physique, compared to their peers (Mayo clinic,2019). Both sexes, but more so boys than girls, may have increases in libido leading to increased masturbation or inappropriate sexual behaviors at a young age. Girls with a history of early puberty have a slightly earlier age of initiation of sexual activity. To add to this, girls also stand a risk of breast cancer because some studies have found an association between early puberty and girls and higher risk of breast cancer. (Paul et al,2018)Diagnosis of precocious puberty is mostly focused on history of extreme growth rate during childhood and the increase level of growth hormone by evidence. Precocious puberty can be easily diagnosed at a very younger age as compared to older kids. Evaluation of a series of blood test and developmental exam is done to help confirm the disorder. In addition to blood test, “X-ray cans also be used to determine the child’s bone age, and which one of them is growing very quickly.” (Mayo, 2019). The use of MRI also helps reveal a tumor in an enlarged Sella turcica, normal bone age, enlargement of bones (such as the paranasal sinuses), and evidence of joint changes. (Hockenberry, 2015). MRI imaging once again can play an essential role in the diagnosis of hypothalamic hamartomas as these may be overlooked on cranial computerized tomography (CT) scans, “the typical MRI picture is that of an isointense structure on T1‐weighted images which may be isointense or slightly hyperintense on T2‐weighted images.” (Partsch et al, 2002).The main goal of intervention for precocious puberty is to prevent the occurrence of early menarche so the child can grow into a normal adult to meet genetic requirement. The treatment of this disorder mostly depends on the cause. However, there are unidentifiable cause in some of them. Those without a cause would not need treatment but would need to be monitored by the medical provider and family. The earlier treatment is initiated, the greater the chances of attaining a normal adult height. (Mayo clinic, 2019). The role of the nurses in treating precocious puberty is to assist patients who in ambulatory settings and are regularly involved in growth screening and should also refer children who demonstrate extreme linear growth for a medical evaluation. It is also ideal for nurses to look out for signs of a tumor, especially headache, and evidence of concurrent hormonal excesses, particularly the gonadotropins, which cause sexual precocity. (Hockenberry&Wilson, 2015). Additionally, the use of effective, long acting GnRH analogues have resulted in significant improvement in height in many, although not all, children with Precocious Puberty caused by both organic conditions and idiopathic CPP, with the best treatment outcomes are seen in those with onset of puberty before 6 years of age. These can be administered as subcutaneous injections, intra-nasally, and as subcutaneous implants. (Nord, 2019).According to Hockenberry, one of the important aspect of nursing management is the need for psychological support and guidance for the child and the family. The family and child both need anticipatory guidance and informational resources to cope with the disorder. It is also crucial for the nurse to provide education to the child and the family on how fertile the child is and therefore must use contraceptive if sexually active. There is also the need for Children with evidence of precocious puberty to be referred to the pediatric endocrinologist for evaluation. (Hockenberry & Wilson , 2015). In conclusion, precocious puberty is a rare disorder among both boys and girls and can impact their self-esteem. It places young girls at high risk for breast cancer and can be managed with medication, MRI, X-ray and also needs an expertise to diagnose. It is recommended for parents to write down key information like symptoms that may seem unrelated to the disorder and also make list of medication and supplements the child might be taking to appointments. ( mayo clinic, 2019). There are many treatment options which require about 6-12months observation and there is the possibility of the child getting back on track with normal growth into adulthood if treatments is started in time.
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