From the Guidelines
Precocious puberty is characterized by the early onset of puberty, before age 8 in girls and before age 9 in boys, and presents with the development of secondary sexual characteristics ahead of the normal timeline. The signs of precocious puberty in girls include breast development, pubic and underarm hair growth, body odor, acne, rapid height increase, and menstruation, while boys typically show enlargement of the testicles and penis, pubic and facial hair growth, voice deepening, acne, body odor, and accelerated growth 1. Children with precocious puberty may experience emotional and social challenges due to their physical development not matching their age.
Key Features
- Breast development in girls
- Enlargement of the testicles and penis in boys
- Pubic and facial hair growth
- Voice deepening in boys
- Acne and body odor
- Rapid height increase
- Menstruation in girls Diagnosis involves physical examination, blood tests to measure hormone levels, bone age X-rays, and sometimes brain imaging, such as MRI, particularly in girls under 6 and boys under 9, as they are more likely to have a central nervous system abnormality 1.
Diagnostic Approach
- Physical examination
- Blood tests to measure hormone levels
- Bone age X-rays
- Brain imaging (MRI) in selected cases Treatment often includes GnRH agonist medications, which pause puberty by reducing sex hormone production, allowing normal growth and development to resume 1.
Treatment Options
- GnRH agonist medications, such as leuprolide (Lupron) or histrelin (Supprelin LA)
- Administration via injections every 1-3 months or as yearly implants The condition may be caused by central factors affecting the brain or peripheral factors directly involving the sex organs, with central precocious puberty being more common, and the need for routine central nervous system imaging is controversial and requires careful clinical consideration 1.
From the Research
Definition and Characteristics of Precocious Puberty
- Precocious puberty is characterized by early pubertal changes, acceleration of growth velocity, and rapid bone maturation that often result in reduced adult height 2.
- It is defined as the appearance of secondary sex characteristics before the age of 8 in girls and 9 in boys 3.
- The condition encompasses a group of heterogeneous conditions that range from variants of normal to slowly progressive and rapidly progressive maturation of both sexes 3.
Clinical Presentation and Evaluation
- Onset of pubertal signs before the age of 8 years in girls and 9 years in boys should always be evaluated carefully 2.
- The clinician evaluating a child with precocious puberty should be aware of the normal events of puberty, the ages at which pubertal milestones are achieved, and the tempo of pubertal progression 3.
- The diagnostic evaluation of the patient includes clinical, laboratory, and radiological investigations 3.
Epidemiology and Trends
- Precocious puberty currently affects 1 in 5,000 children and is 10 times more common in girls 4.
- Statistics indicate that girls in the United States are maturing at an earlier age than they did 30 years ago, and the number of girls with diagnosed precocious puberty is on the rise 4.
- Proposed causes of early sexual maturation in female children include genetic, ethnic, and pediatric obesity, as well as environmental toxins that disrupt endocrine function, psychosocial stress, and early exposure to a sexualized society 4.