Precocious puberty

Precocious puberty is puberty that occurs at an age before the normal for the population. This is generally younger than eight years in females, and younger than nine years in males (1).

Precocious puberty may be (2):

• true - the course and pattern are normal, but early

central precocious puberty

• resulting from early commencement of pulsatile secretion of gonadotrophin releasing hormone (GnRH) (gonadotrophin dependent precocious puberty or GDPP)

• involves the premature activation of the hypothalamic-pituitary-gonadal (HPG) axis
  
  
• pseudo - the pattern is abnormal

peripheral precocious pubertyprecocious pseudopuberty

• related to increased sex steroid production, independent of GnRH (gonadotrophin independent precocious puberty or GIPP)

Notes:

• thelarche and increased growth velocity before age 8 in girls and genital development in boys before age 9 suggests precocious puberty
• precocious puberty in boys represents a substantial risk of underlying pathology
  • this scenario requires urgent referral to a paediatric endocrinologist
• many cases of precocious puberty in girls over 6 have benign causes
  • however precocious puberty can indicate serious pathology in some cases
• " Idiopathic" precocious puberty is the commonest cause of GDPP
  • more commonly seen in girls than boys
• specialist review is indicated if the diagnosis of precocious puberty is suspected (3)
  • however a review notes that (4):
    • although there is a chance of finding pathology in girls with signs of puberty before 8 years of age and in boys before 9 years of age, the vast majority of these children with signs of apparent puberty have variations of normal growth and physical development and do not require laboratory testing, bone age radiographs, or intervention
    • the most common of these signs of early puberty are premature adrenarche (early onset of pubic hair and/or body odor), premature thelarche (nonprogressive breast development, usually occurring before 2 years of age), and lipomastia, in which girls have apparent breast development which, on careful palpation, is determined
      to be adipose tissue
    • indicators that the signs of sexual maturation may represent true, central precocious puberty include progressive breast development over a 4- to 6-month period of observation or progressive penis and testicular enlargement, especially if accompanied by rapid linear growth

Reference:

• Muir A.Precocious puberty. Pediatr Rev 2006;27:373-81.
• Saenger P, Rincon M.Precocious puberty: McCune-Albright syndrome and beyond.J Pediatr. 2003 Jul;143(1):9-10.
• Bradley S et al. Precocious puberty. BMJ. 2020 Jan 13;368:l6597
• Kaplowitz P. Evaluation and Referral of Children With Signs of Early Puberty. Pediatrics 2016 Jan;137(1). doi: 10.1542/peds.2015-3732.