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Sexual precocity is the general term for early puberty. Isosexual precocity refers to a girl who feminizes or a boy who virilizes early. Central precocious puberty or true precocious puberty is a term reserved for children with gonadotropin-releasing hormone (GnRH)-dependent early puberty that follows the normal pubertal pattern and the normal control mechanisms through GnRH. The only difference from normal puberty is the earlier age at onset. Central precocious puberty can be idiopathic or caused by organic conditions such as a brain tumor or a hamartoma of the tuber cinereum. GnRH-independent isosexual precocity is caused by excessive estrogen secretion in girls or androgen secretion in boys from sources other than the GnRH-gonadotropin axis (such as the gonads, the adrenal glands, ectopic human chorionic gonadotropin (hCG) secretion, and exogenous sources of sex steroids). Gonadotropins are suppressed by negative feedback in all forms of GnRH-independent isosexual precocity because sex steroid secretion is autonomous. Contrasexual (or heterosexual) precocity refers to girls who virilize and boys who feminize.


Onset of puberty among Caucasian girls as early as 7 years of age or among African American girls as early as 6 years of age can be considered normal if there are no neurologic symptoms or signs of increased intracranial pressure, if there is not a rapid advancement in pubertal development or bone age, and if menses is after at least age 9 years. If there is a family history of a pattern of early pubertal development, the child is even more likely to have a variant of normal puberty rather than a pathologic condition causing sexual precocity. Among boys the earliest limit of normal puberty is 9 years of age. Onset earlier than these limits is considered sexual precocity.1 The classification schema and causes of precocious puberty are outlined in Table 541-1.

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Table 541-1. Causes and Classification of Sexual Precocity

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