Central Precocious Puberty: Puberty Before Its Time

Actor Portrayals

CPP is when puberty
starts too soon

While puberty is a normal part of growing up, some children may go through puberty sooner than expected. This condition is called central precocious puberty, or CPP

before

age 8

in girls

before

age 9

in boys

CPP is rare, affecting only 1 in 5000 to 1 in 10,000 children in the United States, and is 10x to 20x more common in girls than boys

How does puberty start?

Puberty begins when a hormone called gonadotropin-releasing hormone, or GnRH, is released by a part of the brain called the hypothalamus.

GnRH causes the body to release 2 more hormones called luteinizing hormone (LH) and follicle-stimulating hormone (FSH) that tell the ovaries to release estrogen in girls, and the testicles to release testosterone in boys.

Estrogen and testosterone cause a lot of the physical changes that happen during puberty, including growth spurts, breast development, and testicle growth.

In children with CPP, this whole process works the same way, but it starts earlier than usual.

Common signs of puberty in girls

Breast development
Menstrual period
Pubic or underarm hair
Oily skin/acne
Adult body odor
Sudden growth spurt

Common signs of puberty in boys

Testicle and penis enlargement
Erections
Voice change
Facial hair
Muscle growth
Pubic or underarm hair
Oily skin/acne
Adult body odor
Sudden growth spurt

How does CPP affect children?

Growth and height

CPP can affect your child’s height in 2 ways:

A child with CPP may go through an early growth spurt and be taller than other children the same age
Children with CPP that go untreated may end up shorter than they should be as adults. This is because their bones start maturing too soon, and their growth plates fuse, or close, too early. As a result, their bones stop growing sooner than they should

Social and emotional impacts

Girls and boys who begin puberty before their peers may be extremely self-conscious about the changes occurring in their bodies. This may affect their self-esteem and may increase their risk of developing depression, eating disorders, or substance abuse, perhaps as a result of standing out before they’re ready for the extra attention.

There are no data demonstrating outcomes of Triptodur on stature, social, or emotional health.

Want help explaining CPP and treatment to your child?

See Trip the Dinosaur’s story, Trip and Growing Up Ahead of Schedule, and follow along as Trip learns about having CPP.

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How is CPP diagnosed?

If your child’s healthcare provider is concerned that your child may have CPP, your child will most likely see a pediatric endocrinologist for a diagnosis. A pediatric endocrinologist is a children’s doctor specializing in diagnosing, treating, and managing disorders involving hormones, including CPP.

Some of the tests and exams used to diagnose CPP may include

Blood tests to measure hormone levels, including a test called a GnRH stimulation test. In children with CPP, the GnRH stimulation test will cause other hormone levels in the body to rise. In children without CPP, these hormone levels will stay the same.

An X-ray of the left hand and wrist to measure how fast your child’s bones are growing (referred to as your child’s bone age).

A physical exam to observe whether your daughter is developing breasts or whether your son’s testicles are starting to get larger, as well as other signs of puberty, such as body odor, acne, and whether pubic hair is starting to grow.

How is CPP treated?

If your child’s doctor determines that treatment is right for your child, he or she will typically start your child on a GnRH agonist.

GnRH agonists work by telling the brain to ignore GnRH (the hormone that causes puberty to start too soon in children with CPP).

When the brain ignores GnRH signals, the other hormones responsible for the changes that go along with puberty—FSH, LH, estrogen, and testosterone—drop to prepuberty levels, and signs and symptoms of puberty slow down or stop.

The goals of treatment with a GnRH agonist are to temporarily stop premature puberty and to slow down how fast your child’s bones are growing.

GnRH agonists are given as injections or as an implant placed just under the skin of your child’s inner arm. Implants are placed every 12 months. Injections can be given every month, every 3 months, or every 6 months, depending on which option you choose.

How to talk to your child about CPP

Children with CPP may have a hard time understanding the changes taking place in their bodies, such as the growth of pubic or underarm hair, the appearance of acne, or the development of body odor. Girls may be upset to see their breasts growing or to get their first period, while boys may be surprised by facial hair or a deepening voice.

It’s not unusual for children with CPP to feel confused or embarrassed by these changes. Because they tend to look older physically, they are often expected to behave more maturely, which can increase the pressure and expectations placed upon them. As a parent, you play a key role in shaping your child’s understanding of CPP and creating a nurturing environment where your child can feel loved and supported.

Get Help Talking to Your Child About CPP

IMPORTANT SAFETY INFORMATION FOR TRIPTODUR

INDICATION

TRIPTODUR is indicated for the treatment of pediatric patients 2 years of age and older with central precocious puberty (CPP).

IMPORTANT SAFETY INFORMATION

Do not use TRIPTODUR in:

Those allergic to gonadotropin releasing hormone (GnRH), GnRH agonist medicines, or any ingredients in TRIPTODUR.
children under 2 years of age
women who are or may become pregnant

Tell your child’s healthcare provider if any of the above conditions apply to your child.

It is important to stick to the dosing schedule (one injection every 24 weeks) in order for the drug to work. Do not miss or delay a scheduled dose.

Some people taking gonadotropin releasing hormone (GnRH) agonists like TRIPTODUR have had new or worsened mental (psychiatric) problems. Mental (psychiatric) problems may include emotional symptoms such as crying, irritability, restlessness (impatience), anger, or acting aggressive. Call your child’s doctor right away if your child has any new or worsening emotional symptoms while taking TRIPTODUR.

Some people taking GnRH agonists like TRIPTODUR have had seizures. The risk of seizures may be higher in people who have a history of seizures, have a history of epilepsy, have a history of brain or brain vessel (cerebrovascular) problems or tumors, are taking a medicine that has been connected with seizures such as bupropion or selective serotonin reuptake inhibitors (SSRIs). Seizures have also happened in people who have not had any of these problems. Call your child’s doctor right away if your child has a seizure while taking TRIPTODUR.

Some people taking triptorelin, the active ingredient in TRIPTODUR, have had serious allergic reactions. Call your child’s doctor or get emergency medical help right away if your child gets any of the following symptoms of a serious allergic reaction: skin rashes, redness, or swelling, severe itching, hives, trouble breathing or swallowing, fast heartbeat, sweating, throat tightness, hoarseness, swelling of face, mouth, and tongue, dizziness or fainting.

The most common side effects of TRIPTODUR include injection site reactions, menstrual (vaginal) bleeding, hot flush, headache, cough, and infections (bronchitis, gastroenteritis, influenza, nasopharyngitis, otitis externa, pharyngitis, sinusitis, and upper respiratory tract infection). These are not all the possible side effects of TRIPTODUR. Tell your child’s healthcare provider if they have any side effect that bothers them or that does not go away.

In the first few weeks after your child receives their first TRIPTODUR injection or after additional injections, TRIPTODUR can cause a brief increase in some hormones. During this time you may notice more signs of puberty in your child, including vaginal bleeding. Call your child’s doctor if signs of puberty continue after 2 months of receiving TRIPTODUR.

Reports of pseudotumor cerebri (idiopathic intracranial hypertension) have been observed in pediatric patients receiving GnRH agonists, including triptorelin. Patients and caregivers should contact their healthcare provider if the patient develops any of following symptoms of pseudotumor cerebri, including headache, and vision issues such as blurred vision, double vision, loss of vision, pain behind the eye or pain with eye movement, ringing in the ears, dizziness, and nausea.

These are not all the possible side effects of TRIPTODUR. Call your doctor for medical advice about side effects.

To report SUSPECTED ADVERSE REACTIONS, contact Azurity Pharmaceuticals, Inc. at 1-800-461-7449, or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

The Important Safety Information does not include all the information needed to use TRIPTODUR safely and effectively. For additional safety information, please consult the full Prescribing Information for TRIPTODUR.