What causes early puberty in girls?

Question

Hello doctor,

This is regarding my younger daughter's health, and I would like to get a second opinion before I make a decision. My younger daughter was 1 year and 6 months old when she came to this new place.

Last year, when she was 5 years old, we had to do a physical examination to get admission into the school. During the examination, the primary care doctor noticed some abnormal growth in her body, like breast buds, and asked us to consult a pediatric endocrinologist for further examination.

We consulted a pediatric endocrinologist and did a complete examination, such as a blood test, bone age, and brain MRI. The MRI came back normal with no issues; the bone age showed 8.5 years old. Also, physical development shows Tanner 2 breast development, Tanner 1 pubic hair, and scanty axillary hair.

Her random LH value was 0.9. The doctor said she is experiencing precocious puberty and needs to be treated. The treatment plan was Lupron or Supprelin. We researched the side effects of Lupron and Supprelin and found that being overweight and unconsciousness affect the body in later stages, and there were many mixed answers. We were confused and were not able to discuss with anyone.

As this was new to us, we left that moment without proceeding with any treatment. Again, this year, we went for another set of examinations, and the results came up with the bone age as 10.5 years. Actually, she is 6 years old. I am attaching the current results for your reference.

The doctor again said that we need to do treatment and to start with Lupron 30 mg every three months. We are still confused about whether to start the treatment. So, we like to have a second opinion.

What will happen if we do not treat?
Will she end up shorter and grow less once she hits puberty?
What are the side effects of Lupron?
Will you be able to tell us the experience shared with any of your patients?
Can this be cured naturally?
Is it due to the environment or the food habits of my place?

If we move to our native environment, will that environment and food habits cure this? We are totally confused and not able to make a firm decision.

Kindly help.

Thank you very much for your guidance and support.

Answer 1

Hi,

Welcome to icliniq.com.

I would agree with doctors that this is precocious puberty and signs of puberty and bone age progressed since recently (attachment removed to protect patient identity).
I am confused with hormonal results, could it be mistaken that these are entered in a wrong spot, because it looks like the data are opposite. Also, can you attach her previous height, pelvic ultrasound and MRI?
If left untreated, your daughter will get menarche in a year or so, she will stop growing two years after that and end up as shorter adult female than her genetics predicted. The main problem would be psychological since she might start to menstruate in second grade.
Regarding Lupron (Leuprorelin) as every medication could have the side effects, but is used for at least 20 years without concern.
I am not aware of herbal medications. Food as a cause, chicken and meat was blamed and BPA (bisphenol A) in plastics. Place change is not going to cure this in any way.

I hope this has helped you.

Kindly follow up if you have more doubts.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

1. This is really reassuring that her MRI is normal (attachment removed to protect patient identity).

2. Height velocity is not too accelerated. Your daughter was growing just above the 97th percentile, but her bone age increased. Bone age progressed 2.5 years in 1 year, which would influence final height.

3. Now, I understand that you have been seeing different doctors and that might also explain the different hormone measurements. It looks like a pelvic ultrasound has not been ordered.

4. I would say that whatever decision you make, it will not do any harm if the height is not an issue and if she has psychosociological support for entering puberty too early.

I hope this has helped you.

Kindly follow up if you have more doubts.

Thank you.