A. Thelarche B. Menarche C. Delayed puberty D. Preconscious puberty
Correct Answer: D. Preconscious puberty
Explanation
Here are the causes of Precocious Puberty (puberty before 8 years in girls), explained in a simple and clear way:
Causes of Precocious Puberty
Precocious puberty is divided into two main types based on its origin:
1. Central Precocious Puberty (CPP)
Cause: Early activation of the hypothalamic–pituitary–gonadal (HPG) axis
This is gonadotropin-dependent puberty.
Common Causes
A. Idiopathic (most common in girls)
- In 80–90% of girls, the exact reason is not known.
- The brain’s puberty-control system becomes active earlier than normal.
B. Brain-related causes
- Hypothalamic hamartoma
- CNS tumors (astrocytoma, ependymoma, glioma)
- CNS infections (meningitis, encephalitis)
- Head trauma
- Hydrocephalus
- Previous radiation to the brain
- Congenital brain anomalies
2. Peripheral Precocious Puberty (PPP)
Cause: Excess sex hormone production independent of HPG axis
This is gonadotropin-independent.
Common Causes
A. Ovarian causes
- Ovarian cysts
- Ovarian tumors (granulosa cell tumors, theca cell tumors)
B. Adrenal causes
- Congenital adrenal hyperplasia (CAH)
- Adrenal tumors
C. Exogenous hormone exposure
- Use of estrogen-containing creams, medications, or accidental hormonal exposure.
D. McCune–Albright Syndrome
- A genetic disorder causing:
- Early puberty
- Café-au-lait spots
- Fibrous dysplasia of bones
E. Hypothyroidism (rare)
- Severe untreated hypothyroidism can cause early puberty (Van Wyk–Grumbach syndrome).
Summary Table
Type Mechanism Causes Central (CPP) Early activation of HPG axis Idiopathic, CNS lesions, infections, trauma, radiation Peripheral (PPP) Sex hormones from ovaries/adrenals or external sources Ovarian cysts/tumors, CAH, adrenal tumors, exogenous estrogen, McCune-Albright, hypothyroidism
Other Options Details
Here are clear and simple descriptions of all the options:
A. Thelarche
- Thelarche is the onset of breast development in girls.
- It is usually the first visible sign of puberty.
- Typically occurs around 8–13 years of age.
B. Menarche
- Menarche refers to the first menstrual period in girls.
- It usually occurs 2–3 years after thelarche.
- Average age is around 12–13 years.
C. Delayed Puberty
- Delayed puberty is when puberty starts later than the normal age range.
- In girls, it is defined as:
- No breast development by 13 years, or
- No menstruation (menarche) by 16 years.
- Causes may include chronic illness, hormonal disorders, or genetic conditions.
D. Precocious Puberty
(Correct spelling: “Precocious,” not “Preconscious”)
- Precocious puberty is the early onset of puberty.
- In girls, it is defined as:
- Breast development or other secondary sexual characteristics before 8 years of age.
- Causes may be central (hormonal axis activation) or peripheral (hormone-producing tumors, ovarian cysts, etc.)
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Writer: Vandita Singh, Lucknow (GS India Nursing Group