Puberty is an important time when you are growing as it is the time that you grow quickly and at the end of puberty several years after starting is when you stop growing. Doctors will therefore be watching for when you go into puberty. Sometimes in young people with CAH it can happen at the right age and sometimes it can happen a little too early so needs stopping for a short while.
Why can some young people have a problem going through puberty too early?
In CAH you produce too much of the adrenal hormones called androgens, the most famous of which is testosterone. Testosterone is the main hormone of puberty in boys but not girls, in girls the main hormone is oestrogen. If the adrenal gland is producing too much androgen because you have just been diagnosed or your hydrocortisone medication is not keeping the levels low it can give you changes usually seen in puberty and also kick start your puberty early by waking up your pituitary gland increasing the gonadotrophins, Luteinizing hormone and follicle stimulating hormone, LH and FSH for short which drive your ovaries to make oestrogen.
Mostly your pituitary gland and ovaries are healthy it is just the hormones from the adrenal gland that are wrong.
How will I know if I am going to have a problem with my puberty?
Girls go into puberty at different times so you may notice that other girls at school are developing even from the age of 8. The first sign is starting to develop breasts. If you develop breasts before the age of 8 that is too early. Another sign of your androgen levels being too high could also be hairs down below or under your arms before the age of 8.
The doctors and nurses will keep a check on how you are growing and if you are showing any signs of puberty. They will also check your androgen levels, androstenedione, 17OHP and testosterone. They will also do a Xray of your hand and wrist every now and then to check the age of your bones.
What if my puberty starts too early?
There are two reasons to stop puberty if it starts too early. The first is you won’t be developing at the same time as other girls at school which might make you feel a bit different and uncomfortable, you may even start your periods before you have left primary school. The second reason is that towards the end of puberty you stop growing so if you start early the earlier you will stop growing and the shorter you will be when you are an adult.
To stop puberty the most important thing is to get those androgen levels down by getting the dose of hydrocortisone spot on. This may be something you have to help with by taking your medication as regularly as possible, so ask for help if you are struggling with this as it is really important. The doctors may also have to stop puberty by giving you an injection that puts the hormones (LH and FSH) from your pituitary gland back to sleep until the right time which is usually just before you are a teenager.