History Taking in Precocious Puberty
A systematic history in suspected precocious puberty must focus on the age of onset, speed of progression of secondary sexual characteristics, family pubertal timing, exposure to exogenous sex steroids, and neurological symptoms to distinguish central from peripheral causes and guide appropriate management. 1, 2
Pubertal Development Timeline
Document the precise age when secondary sexual characteristics first appeared, as onset before age 8 in girls or age 9 in boys defines precocious puberty and warrants endocrine evaluation 1, 3, 4
Assess the rate of progression of pubertal changes, including breast development (thelarche), pubic hair (pubarche), and menarche in girls, as rapidly progressive forms require more urgent intervention than slowly evolving variants 2, 5
Specifically ask about menarche timing in girls age 9 years, determining whether other pubertal signs are present and their progression timeline, as isolated menarche may represent a different clinical entity 1
Distinguish isolated findings from complete pubertal development, as isolated pubic hair without breast development suggests adrenal androgen production rather than true central precocious puberty 6
Growth Pattern Assessment
Obtain detailed growth velocity data, asking parents about recent acceleration in linear growth, as precocious puberty characteristically causes both accelerated growth and advanced bone maturation that ultimately compromises adult height 1, 6, 7
Document current height, weight, and plot on growth curves to identify accelerated linear growth patterns that may indicate excess androgen or estrogen exposure 6
Family and Genetic History
Obtain detailed family history of pubertal timing in parents and siblings, as familial patterns can help distinguish constitutional variants from pathologic early puberty 1
Ask specifically about family members with early puberty, particularly maternal age at menarche, as this provides context for genetic predisposition 1
Exposure History
Systematically inquire about potential exposure to exogenous sex steroids, including topical testosterone preparations, estrogen-containing creams, oral contraceptives, or supplements that family members may be using 1, 2
Ask about environmental exposures to endocrine-disrupting chemicals, though the clinical risk is considered low, this remains a potential contributing factor 1
Neurological Symptoms
Screen for neurological symptoms including severe headaches, visual changes, or seizures, as these are crucial red flags for CNS pathology causing central precocious puberty and mandate brain MRI 1, 2
Document any history of head trauma, CNS infections, or prior brain surgery, as these can predispose to hypothalamic-pituitary dysfunction 2
Past Medical History
Review history of cancer treatment, particularly chemotherapy with alkylating agents or radiotherapy potentially exposing the ovaries, as these patients require specific surveillance protocols 8
Document any chronic medical conditions, particularly those affecting the hypothalamic-pituitary-gonadal axis 2
Psychosocial Assessment
Evaluate for behavioral problems, mood symptoms, and psychosocial adjustment, as early puberty is associated with increased risk of behavioral problems and psychological distress that may require early intervention 1, 9
Assess the child's and family's concerns about early development, as psychosocial impact is a legitimate indication for treatment beyond auxologic considerations 3, 2
Physical Examination Context
Ensure Tanner staging is carefully documented during examination, as this determines whether findings represent true precocious puberty versus isolated variants like premature adrenarche 6
Plan for pelvic ultrasound consideration based on history findings, particularly if there are concerns for ovarian tumors, cysts, or to assess uterine size as a marker of estrogen exposure 1, 6
Common Pitfalls to Avoid
Do not dismiss slowly progressive forms without proper evaluation, as even girls with predicted adult height >155 cm may have significant estrogenization requiring monitoring, though they may not need immediate GnRH analog therapy 5
Do not assume idiopathic etiology in boys, as precocious puberty in males is commonly due to identifiable pathology on imaging, unlike in girls where most cases are idiopathic 4
Do not overlook the need for brain MRI in high-risk groups, particularly girls under age 6 who have the highest risk of CNS abnormalities, whereas girls aged 6-8 years have lower risk (2-7%) but still warrant consideration based on clinical presentation 1