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The complex system of glands known as the endocrine system regulates body functions including growth and puberty. Some treatments for childhood cancer can damage these glands and cause a variety of problems, including starting puberty earlier than usually expected (precocious puberty).
Precocious puberty occurs when children have signs of puberty at a younger age than usually expected. Most doctors agree that children have the condition if they develop sexual traits (such as pubic hair or breast growth) before age 8 years in girls and before age 9 years in boys. Usually, puberty begins between ages 8 and 13 years for girls and 9 and 14 years for boys.
In addition to having early signs of puberty, children with precocious puberty often have a growth spurt with rapid bone growth. But bones that mature early have less time to grow, which results in a final adult height that is actually much shorter than normal.
Radiation to the head or brain (including eyes, ears, nose, or mouth areas) can damage the hypothalamus and pituitary glands. The damage causes them to signal the ovaries (in girls) or testicles (in boys) to make hormones earlier than normal, prompting signs of puberty. In other cases, signs of puberty occur because of changes in the ovaries, testicles, or adrenal glands.
Other factors that increase risk include female sex, younger age at cancer treatment, and being overweight.
Your child's doctor can order tests that will tell if the cause of precocious puberty is in the brain or another part of the body.
All childhood cancer survivors should have a long-term follow-up exam at least once a year. This exam should include measurement of height and weight and assessment of pubertal progress. If signs of fast growth or early puberty are present, your child's doctor may order a blood test to check his or her hormone levels. Some children might also need an x-ray that measures bone age.
If any hormone problems are found your child will be referred to a doctor who specializes in hormones (endocrinologist). Medicine is sometimes used to stop puberty for a while and to decrease how fast bones mature.
It's also important to talk with your child's primary doctor about how you can help manage the emotional effects of beginning puberty too early. Although children with precocious puberty may look mature, their thoughts, emotions, and behaviors are still that of their actual age. Your child's doctor can recommend a mental health specialist if needed, too.
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