From the Guidelines
Precocious puberty should be managed with GnRH analogs to preserve final adult height, delay menarche, and optimize development of secondary sex characteristics, with treatment usually continuing until the normal age of puberty, which typically begins between ages 8-13 in girls and ages 9-14 in boys. The approach to precocious puberty involves a comprehensive evaluation to distinguish between central precocious puberty (CPP) and peripheral causes, including physical examination, bone age assessment, and hormone level testing 1. For CPP, GnRH agonists such as leuprolide acetate or histrelin implants are the standard treatment to suppress pubertal development until an appropriate age, working by downregulating pituitary GnRH receptors, thereby reducing gonadotropin release and sex hormone production. Some key points to consider in the management of precocious puberty include:
- Confirming the diagnosis through thorough evaluation
- Distinguishing between central and peripheral precocious puberty
- Using GnRH agonists for CPP
- Targeting the underlying cause for peripheral precocious puberty
- Considering the child's psychological well-being, growth potential, and rapidity of pubertal progression in treatment decisions, as noted in guidelines for the assessment and management of female reproductive complications 1. Normal puberty typically begins with breast development (thelarche) in girls, which can occur before age 8 years, but Tanner stage 2 breast development before 8 years of age is a reasonable definition of precocious puberty 1. The goal of treatment is to allow normal physical and psychosocial development while maximizing adult height potential, and treatment decisions should be made with consideration of the child's individual needs and circumstances, as informed by guidelines for the assessment and management of female reproductive complications 1.
From the Research
Approach to Precocious Puberty
The approach to precocious puberty involves a detailed history and physical examination, followed by several investigations, including:
- Estimation of serum gonadotropins such as luteinizing and follicle-stimulating hormones and sex steroids 2
- Radiographic workup and thyroid function tests 2
- Treatment depends on the type of precocious puberty, with long-acting GnRH agonists being the norm of care for central precocious puberty (CPP) management 2, 3, 4
- For peripheral precocious puberty (PPP), the goal of management is to suppress adrenal androgen secretion by glucocorticoids, and anastrozole and letrozole may be used in certain cases 2
Normal Age for Puberty
The normal age for puberty is:
- Between 8 and 13 years for girls, with thelarche (breast development) being the first sign of puberty 2, 5, 6
- Between 9 and 14 years for boys, with testicular enlargement being the first sign of puberty 2, 5, 6
- Precocious puberty is defined as the appearance of secondary sex characteristics before the age of 8 in girls and 9 in boys 2, 3, 5, 6
Types of Precocious Puberty
There are two types of precocious puberty:
- Central precocious puberty (CPP), which is gonadotropin-dependent and due to premature maturation of the hypothalamic-pituitary-gonadal (HPG) axis 2, 3, 4
- Peripheral precocious puberty (PPP), which is gonadotropin-independent and refers to the development of early pubertal maturation not related to the central activation of the HPG axis 2, 3