Summary
Definition
History and exam
Key diagnostic factors
- boys: testes ≥4 mL
- girls: breast development
- pubic/axillary hair
- menarche
- increased growth velocity
- tall stature
Other diagnostic factors
- café au lait spots
- symptoms of other autonomous endocrine hyperfunction
- polyostotic fibrous dysplasia
- neurofibromas, axillary freckling, and kyphoscoliosis
- facial dysmorphism
- clitoromegaly
- eye abnormalities
- motor deficits
- abnormal head size
Risk factors
- brain tumors
- cranial irradiation
- McCune-Albright syndrome
- gonadal tumors
- congenital adrenal hyperplasia (CAH)
- positive family history
- exposure to exogenous hormones
- head injury
- neurofibromatosis type 1
- previous central nervous system infections
- hydrocephalus
- congenital pituitary abnormalities
- adoption
- sexual abuse
Diagnostic tests
1st tests to order
- Tanner staging
- measurement of testicular size
- bone age assessment
- basal follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
- gonadotropin-releasing hormone (GnRH) stimulation test
- serum testosterone
- serum estrogen
- ultrasound pelvis
Tests to consider
- MRI brain
- CT brain
- 17-hydroxyprogesterone
- urinary steroid profile
- adrenocorticotropic hormone (ACTH) stimulation test
- CT or MRI adrenals
- ultrasound adrenals
- bone scan/skeletal survey
- other pituitary hormone investigations
- genetic testing
- thyroid function tests
Emerging tests
- overnight gonadotropin profile
Treatment algorithm
central precocious puberty (CPP)
gonadotropin-independent precocious puberty (GIPP)
Contributors
Authors
Talat Mushtaq, BSc, MBCHB, MRCPCH, MD
Paediatric Endocrinology Consultant
Leeds Teaching Hospitals NHS Trust
Leeds
UK
Disclosures
TM has received support from Novo Nordisk and Pfizer to attend overseas conferences. He has also received honoraria from Kyowa Kirin for lectures and educational events.
Sasha Howard, MBBS, MRCPCH, MSc, PhD
Senior Lecturer and Honorary Consultant in Paediatric Endocrinology
Queen Mary University of London
Barts Health NHS Trust
London
UK
Disclosures
SH has received speaking honoraria from Sandoz and Novo Nordisk.
Acknowledgements
Dr Talat Mushtaq and Dr Sasha Howard would like to gratefully acknowledge Dr Ameeta Mehta and Professor Peter Hindmarsh, previous contributors to this topic.
Disclosures
AM and PH are authors of several references cited within this topic.
Peer reviewers
Malcolm Donaldson, MD, FRCP, FRCPCH, DCH
Senior Lecturer in Child Health
Department of Child Health
Royal Hospital for Sick Children
Glasgow
UK
Disclosures
MD has received lecture fees and financial support from pharmaceutical companies (Pfizer, Novo Nordisk, Serono) that manufacture growth hormone and whose brands of growth hormone MD recommends. MD is also an author of articles cited in this topic.
Paul Kaplowitz, MD, PhD
Professor Emeritus
Division of Endocrinology
Children's National Hospital
Washington
DC
Disclosures
PK declares that he has no competing interests.
References
Key articles
Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969 Jun;44(235):291-303.Full text Abstract
Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970 Feb;45(239):13-23.Full text Abstract
Bangalore Krishna K, Fuqua JS, Rogol AD, et al. Use of gonadotropin-releasing hormone analogs in children: update by an international consortium. Horm Res Paediatr. 2019;91(6):357-72.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Premature thelarche
- Premature adrenarche
- Congenital adrenal hyperplasia (CAH)
More DifferentialsGuidelines
- GnRH analogue stimulation testing to investigate precocious puberty
- Use of gonadotropin-releasing hormone analogs in children: update by an international consortium
More Guidelines
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