More and more young patients are consulting for early puberty. Some are not even 6 years old. The causes of this condition, which can lead to stunted growth, are not well understood
At 7 years old, Elodie goes every month to her pediatrician to receive an injection to slow down pubertal development. Her parents agreed to this hormonal treatment, which is also given to prostate cancer patients. Elodie suffers from what is called precocious puberty, a hormonal dysfunction that is affecting more and more children. What is it really like? Is the situation alarming in French-speaking Switzerland?
“For the past few years, I have seen an increase in the number of children aged 6 to 8 years with signs of early puberty in my consultation. A few rare children are only 5 years old”,
says Valérie Schwitzgebel, professor in charge of the pediatric endocrinology and diabetology unit at the University Hospitals of Geneva (HUG).
Specialists distinguish two groups of early puberty, those known as central puberty due to the premature onset, linked or not to a lesion, of the hypothalamo-hypophyseal axis (which governs hormonal secretions), and the so-called peripheral ones, which result in the early and isolated development of breasts or hair, without accelerating growth and bone maturation.
Risk of breast cancer
Early central puberty is eight times more common in girls than in boys. Under the age of 8, these girls show signs of breast development with pubic hair and an advance in bone age that leads to premature growth arrest. “Before any treatment, we check for the absence of a possible brain tumor with an MRI and perform a hormonal assessment,” explains Franziska Phan-Hug, an associate physician at the University Hospital of Vaud (CHUV) and specialist in pediatric endocrinology.
Only in cases of proven central precocious puberty, a drug treatment is proposed. “We are seeing more and more patients at the CHUV with signs of precocious puberty, but only a few cases are treated with an antagonist of a hormone called GnRH,” says the doctor.
Growth is the number one concern of families. “We decided to undergo treatment because we were afraid Elodie would not reach five feet tall as an adult,” says her mother, who was in for a real shock when the diagnosis was made. The treatment should allow her to gain 2 to 10 centimeters. Valérie Schwitzgebel from the HUG insists on the importance of the follow-up of these children:
“Hormone treatments must be taken in a timely manner.”
However, size is not the only issue: there is also a mismatch between the body and the mind. These children suffer from their difference. “Having your period at 8 years old can be very disturbing. In addition, early menarche increases the risk of breast cancer,” adds Valérie Schwitzgebel.
Endocrine disruptors involved
While cases of central precocious puberty remain rare and occur in about 1 in 5000 to 10 000 children, cases of peripheral precocious puberty are much more common. But there are no statistics in Switzerland.
“I am seeing more and more girls under the age of 8 with breast development. These peripheral puberties start quickly but usually progress slowly,” says Franziska Phan-Hug. The age of onset of menarche is usually normal. In the end, there is often just a prolongation of the duration of puberty. These cases are indeed more numerous, but the situation is not necessarily worrying if a central precocious puberty could be ruled out. However, it is important to remain vigilant for potential contributing factors, such as endocrine disruptors or obesity.”
Precocious puberty – both peripheral and central – which seems to be increasing in all industrial countries over the last 15 to 20 years, has causes that are still poorly understood. Obesity would be partly responsible because the fatty tissue induces hormonal imbalances. Some substances are also pointed out, namely endocrine disruptors (pesticides, bisphenol A, phthalates, etc.) that act on the hormonal balance. Micropollutants in drinking water are also discussed.
“We don’t have the means to evaluate the environmental impact on early puberty. Each time, we carry out questionnaires which sometimes reveal interesting elements. For example, we had the case of a 5 year old girl who had been treated with lavender oil and who had developed mammary glands. When this oil was removed, the problem was resolved. I advise families to avoid chemical products as much as possible, but also to control the child’s weight”,
recalls Valérie Schwitzgebel, who confirms however the vagueness which reigns on the causes of this pathology.