Guest: Dr. Deborah A. Bowlby - Pediatric Endocrinology
Host: Dr. Linda Austin – Psychiatrist
Announcer: Welcome to an MUSC Health Podcast.
Dr. Linda Austin: I am Dr. Linda Austin. I am talking with Dr. Deborah Bowlby, who is a Pediatric Endocrinologist. Dr. Bowlby, in your line of work, I am sure one of the common problems that parents bring kids in for is early puberty or precocious puberty. Do boys come in with that question as well as girls it seems to me that it’s more girls, where parents become concerned, is that, is there a gender difference there?
Dr. Deborah A. Bowlby: Definitely, we see a lot of patients for evaluation of early puberty specifically for girls. If a girl has pubertal development before the age of eight, they should be evaluated. For boys, if they have pubertal development before the age of nine, they should also be evaluated by pediatric endocrinologist. It is definitely true that we evaluate more girls for concern regarding precocious puberty. For girls, most of the time we find a benign process and we are able to monitor pubertal development. A common diagnosis for girls who truly have precocious puberty is known as idiopathic central precocious puberty. This is where basically the brain gets turned on and puberty starts.
Dr. Linda Austin: Idiopathic meaning, we don’t know.
Dr. Deborah A. Bowlby: Exactly, that there isn’t a dangerous process happening. It’s a normal pubertal process just starting early.
Dr. Linda Austin: When you say pubertal development before age eight for girls and nine for boys, what are you speaking of specifically?
Dr. Deborah A. Bowlby: So for girls, the concern would be breast development, pubic hair, or hair under the arms or certainly development of periods. For boys, you can see a change in testicular size, the length of the penis, or again pubic hair or hair under the arms.
Dr. Linda Austin: I would imagine in taking care of these kids. It must take so much sensitivity on your part to help them name us, I would just imagine it would be tough for children to be brought in and examined.
Dr. Deborah A. Bowlby: It definitely is a sensitive topic for the patient and for their families. However, we provide a very supportive environment and we also have physicians who are both females and males and that sometimes can help alleviate a sensitive topic.
Dr. Linda Austin: So, is it fair to say that most of the time then it’s a benign thing, it happens for reasons you don’t really understand, they are just a little ahead of themselves in their development, and you reassure the parents and that’s the end of it.
Dr. Deborah A. Bowlby: So, for many patients, yes; it’s a benign process that we follow. However, for some of the girls if they have had this early development, we have ways to slow down the pubertal development. With regards to boys if they start having significant pubertal development at an early age, there often is a more of a concern and we might actually find more of a problem.
Dr. Linda Austin: What type of problem?
Dr. Deborah A. Bowlby: With boys, we certainly get an MRI of the brain to assess if there are any structural problems in addition to examining the hormones in their blood.
Dr. Linda Austin: For example a tumor.
Dr. Deborah A. Bowlby: Correct.
Dr. Linda Austin: So, you get up a tumor then secreting hormones early that might be causing the problems.
Dr. Deborah A. Bowlby: Certainly for boys, it’s one of our concerns.
Dr. Linda Austin: But not for girls.
Dr. Deborah A. Bowlby: In girls, it’s more common to have this idiopathic triggering of the brain to turn on puberty a little bit early. That’s probably also the reason why we see more girls referred to our practice than boys.
Dr. Linda Austin: So, you mentioned that you could turn off this process with girls, how do you do that?
Dr. Deborah A. Bowlby: If a girl is diagnosed with central idiopathic precocious puberty, which is the brain turning on too early, we are able to keep the pubertal process quite by giving an injection of a medication called Lupron. Lupron slows the pubertal process.
Dr. Linda Austin: There must be a relief for parents, who know that there is a treatment.
Dr. Deborah A. Bowlby: Definitely, and it’s quite simple. Lupron is an injection given once a month and is generally very well tolerated by the patients.
Dr. Linda Austin:As a psychiatrist, of course, I can’t resist asking. What are the psychological effects on children of going through puberty too early?
Dr. Deborah A. Bowlby: The concerns we have with early puberty are one, you can have a pubertal growth spurt quite early and then have an adult height as much shorter than expected. You also have the concerns that you don’t have the maturity to handle the changes that your body is going through and this unfortunately also sort of sets you up for inappropriate behavior by adult to a child. So, it’s also very important to treat some of these children to protect them.
Dr. Linda Austin: So, to allow children to be children just as long as all the other kids of that way because kids are so sensitive to wanting to be just like all the other kids.
Dr. Deborah A. Bowlby: Correct, to allow children to develop along with their peers.
Dr. Linda Austin: I remember in child psychiatry learning that no matter how mature a child may be intellectually or physically, emotional life can really never outpace itself that is so important for children to go through the normal stages of development in a well paced, not speeded up way.
Dr. Deborah A. Bowlby: Correct and that’s what we strive to achieve for these patients.
Dr. Linda Austin: Dr. Bowlby, thank you so much for talking with us today.
Dr. Deborah A. Bowlby: Thank you.
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