Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features ++ Defined as pubertal development occurring below the age limit set for normal onset of puberty More common in girls than in boys Many girls showing signs of puberty between 6 and 8 years of age have a benign, slowly progressing form that requires no intervention Age of pubertal onset may be advanced by obesity Central precocious puberty in girls is generally idiopathic but may be secondary to a central nervous system (CNS) abnormalities, including but not limited to Hypothalamic hamartomas CNS tumors Cranial irradiation Hydrocephalus Trauma Peripheral precocious puberty (GnRH-independent) Occurs independent of gonadotropin secretion Can be caused by ovarian or adrenal tumors, ovarian cysts, late-onset congenital adrenal hyperplasia, McCune-Albright syndrome, or exposure to exogenous estrogen +++ Clinical Findings ++ Usually starts with breast development followed by pubic hair growth and menarche Girls with ovarian cysts or tumors generally have signs of estrogen excess such as breast development and possibly vaginal bleeding Adrenal tumors and congenital adrenal hyperplasia produce signs of androgen excess which include pubic hair, axillary hair, acne, and increased body odor Children with precocious puberty usually have accelerated growth and skeletal maturation, and may temporarily be tall for age +++ Diagnosis ++ If the bone age is advanced, further laboratory evaluation is warranted In girls with an ovarian cyst or tumor, estradiol levels will be markedly elevated In central precocious puberty, Random follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations may still be in the prepubertal range If so, documentation of the maturity of the hypothalamic-pituitary axis depends on demonstrating a pubertal LH response after stimulation with a GnRH agonist In peripheral precocious puberty, the LH response to GnRH stimulation is suppressed by feedback inhibition of the hypothalamic-pituitary axis by the autonomously secreted gonadal steroids In girls with pubic or axillary hair but no breast development, androgen levels (testosterone, androstenedione, dehydroepiandrosterone-sulfate) and 17-hydroxyprogesterone should be measured When a diagnosis of central precocious puberty is made, an MRI of the brain should be done to evaluate for CNS lesions When laboratory test results suggest peripheral precocious puberty, an ultrasound of the ovaries and/or adrenal gland may be indicated +++ Treatment ++ Two most common GnRH analogs that downregulate pituitary GnRH receptors and thus decrease gonadotropin secretion are leuprolide, which is given as a monthly intramuscular injection, and histrelin subdermal implant, which is replaced annually In a girl with an ovarian cyst, intervention is generally not necessary, as the cyst usually regresses spontaneously Surgical resection and possibly chemotherapy are indicated for the rare adrenal or ovarian tumor Aromatase inhibitors, which block the production of estrogen, may be effective in treating McCune-Albright syndrome Attention to the psychological needs of the patient and family is essential Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth