Prijevremeni pubertet

Pubertet definiramo kao razdoblje razvoja ljudske jedinke, i kao takav, on je obiljeţen zamahom rasta, razvojem spolnih organa i sekundarnih spolnih osobina ĉime jedinka stiĉe svoju sposobnost za reprodukciju. Zapoĉinje pulsatilnom sekrecijom GnRH koji pokreće hipotalamus – hipofiza – gonadnu os. MeĊutim primarni mehanizam koji pokreće ovo cjelokupno zbivanje i nadalje je nepoznat. Najpoznatiji sustav za procjenu pubertetskog razvoja je stupnjevanje po Tanneru. U djevojĉica pubertet zapoĉinje rastom dojki, a ubrzo ga slijedi pojava pubiĉne i aksilarne dlakavosti te kasnije pojava prve menstruacije. U djeĉaka pubertet zapoĉinje povećanjem testisa, rastom penisa, pojavom pubiĉne i aksilarne dlakavosti te brade. Dosadašnji podaci ukazuju na to da 95% djece ulazi u pubertet u predviĊenom vremenskom razdoblju, za djevojĉice ono je u dobi od 8. – 13. godine, dok je za djeĉake u dobi od 9,5 - 13,5 godina. Ostalih 5 % u pubertet ulazi ili prijevremeno ili kasno. Pubertet definiramo preuranjenim ukoliko pojava kliniĉkih i hormonalnih znakova pubertetskog razvoja u djevojĉica zapoĉne prije 8. godine, a u djeĉaka prije 9. godine ţivota. Ukoliko pubertet u djevojĉica zapoĉne izmeĊu 8. i 10. godine, te u djeĉaka izmeĊu 9. i 11. godine ţivota, radi se o ranom, ali ne i prijevremenom pubertetu. Prijevremeni pubertet najĉešće nastaje ranom aktivacijom hipotalamus - hipofiza- gonadne osi i tada govorimo o centralnom, gonadotropin ovisnom, potpunom ili pravom prijevremenom pubertetu. A ukoliko fiziĉke promjene pokrenu spolni hormoni tada govorimo o perifernom, gonadotropin neovisnom, nepotpunom ili laţnom prijevremenom pubertetu. Tako rani poĉetak puberteta moţe prouzroĉiti probleme poput niske završne visine rasta te emocionalnog poremećaja. Najvaţniji kriterij u donošenju odluke o uvoĊenju terapije GnRH analozima sama je progresija pubertetskog razvoja.Puberty is define as a period of the development of a human being, and like that it is marked by the growth momentum, the development of sexual organs and the secondary sexual characteristics, thus achieving the individual's ability to reproduce. It is initiated by the pulsatile secretion of GnRH which triggers thehypothalamic - pituitary - ovarian axis. However, the primary mechanism that triggers this overall phenomenon is still unknown. The most well-known system for assessing puberty is the degree of Tanner. In a girl it begins with breast growth, and soon is followed by the appearance of pubic and axillary hair and subsequent appearance of the first menstrual period. In a boy, puberty begins with increasing testicles, penis growth, pubic and axillary hair growth and hair on chin. Previous data suggest that 95% of children enter puberty in the predicted time of that period, for girls it is between the ages of 8 and 13, and for boys ages 9.5 to 13.5. The other 5% in puberty enter either earlier or later. Puberty is defined as precocious puberty if the occurrence of clinical and hormonal signs of puberty in girls begins before 8 years and in boys before 9 years of age. If puberty begins in girls between 8 and 10, and in boys between the ages of 9 and 11, it is early but not precocious puberty. Early puberty is most commonly caused by early activation of the hypothalamic – pituitary - ovarian axis and then we are talking about central, gonadotropindependent, complete or right precocious puberty. And if physical changes trigger sex hormones then we talk about peripheral, gonadotropin independent, incomplete or false precocious puberty. Such early puberty starts can cause problems such as low height growth and emotional disturbance. The most important criterion in deciding to introduce GnRH analogs therapy is the progression of puberty development