Last reviewed: 24 Feb 2023
Last updated: 28 Feb 2020
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- boys: testes >4 mL
- girls: breast development
- pubic/axillary hair
- menarche
- increased growth velocity
- tall stature
More key diagnostic factors
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
Other diagnostic factors
Risk factors
- brain tumours
- cranial irradiation
- McCune-Albright syndrome
- gonadal tumours
- 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
More risk factors
Diagnostic investigations
1st investigations to order
- bone age assessment
- basal follicle-stimulating hormone (FSH) and luteinising hormone (LH)
- serum testosterone
- serum oestrogen
- ultrasound pelvis
- LHRH stimulation test
More 1st investigations to order
Investigations 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
More investigations to consider
Emerging tests
- overnight gonadotrophin profile
Treatment algorithm
ACUTE
gonadotrophin-dependent precocious puberty (GDPP)
gonadotrophin-independent precocious puberty (GIPP)
Contributors
Authors
Ameeta Mehta, MBBS, DCH, DNBE, MSc, MRCP, MD
Paediatric Endocrinologist
London
UK
Disclosures
AM is an author of several articles cited within this topic.
Peter Hindmarsh, BSc, MD, FRCP, FRCPCH
Professor of Paediatric Endocrinology
University College London
London
UK
Disclosures
PH is an author of several articles 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) who manufacture growth hormone and whose brands of growth hormone MD recommends. MD is also an author of articles cited in this topic.
Dianne Deplewski, MD
Assistant Professor of Pediatrics
University of Chicago
Chicago
IL
Disclosures
DD declares that she has no competing interests.
Differentials
- Premature thelarche
- Premature adrenarche
- Congenital adrenal hyperplasia (CAH)
More DifferentialsGuidelines
- Evaluation and referral of children with signs of early puberty
- Consensus statement on the use of gonadotropin-releasing hormone analogs in children
More Guidelines
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