From the Guidelines
Precocious puberty is a condition where a child's body begins to develop sexual characteristics earlier than normal, typically before age 8 in girls and before age 9 in boys, due to early activation of the hypothalamic-pituitary-gonadal (HPG) axis. This condition occurs when the body starts producing sex hormones prematurely, causing early breast development, pubic hair growth, menstruation in girls, and testicular enlargement in boys. According to the most recent evidence 1, central causes of precocious puberty are often idiopathic; however, this may be related to intracranial neoplasms, trauma, infection, hydrocephalus, and some syndromes with premature gonadotropin-releasing hormone production. Some key points to consider in the diagnosis and management of precocious puberty include:
- The age of the child at symptom onset is important, where girls <6 and boys younger <9 are most likely to show a central nervous system abnormality and therefore should be screened with MRI 1.
- For girls 6 to 8 years of age, the likelihood of identifying a central nervous system lesion is lower, estimated between 2% to 7%, and neoplastic in 1% 1.
- Treatment for precocious puberty uses GnRH analogs to preserve final adult height, delay menarche, and optimize development of secondary sex characteristics 1.
- Medical evaluation is essential as precocious puberty can sometimes indicate underlying medical conditions like tumors or genetic disorders.
- Without treatment, children with precocious puberty may experience psychological distress from looking different from peers and may ultimately have shorter adult height due to premature closure of growth plates in bones. The definition of precocious puberty may vary, but Tanner stage 2 breast development before 8 years of age is a reasonable definition of precocious puberty 1.
From the Research
Definition of Precocious Puberty
- Precocious puberty is defined as the onset of pubertal changes before the age of 8 in girls and 9 in boys 2
- It is characterized by the early development of secondary sexual characteristics, such as breast growth, pubic hair, and voice changes
Causes and Types of Precocious Puberty
- Central precocious puberty (CPP) is the most common form, caused by the premature activation of the hypothalamic-pituitary-gonadal axis 3, 4
- Peripheral precocious puberty is caused by the production of sex hormones outside the hypothalamic-pituitary-gonadal axis 2
Diagnosis and Treatment of Precocious Puberty
- Diagnosis is based on physical examination, medical history, and laboratory tests, including hormone levels and bone age assessment 4, 5
- Treatment options include gonadotropin-releasing hormone agonists (GnRHa), such as leuprolide acetate, which can effectively suppress pubertal development and improve predicted adult height 3, 4, 5, 6
- The choice of treatment depends on the individual child's needs and concerns, as well as the specific characteristics of the available GnRHa options 3
Effects of Treatment on Growth and Development
- GnRHa treatment can slow down or stop the progression of pubertal changes, allowing for a more normal growth and development pattern 4, 5
- Treatment can also improve predicted adult height, especially if started early and monitored regularly 6
- The safety profile of GnRHa treatment is generally good, with few adverse events reported 4, 5