小结
定义
病史和体格检查
关键诊断因素
- boys: testes ≥4 mL
- girls: breast development
- pubic/axillary hair
- menarche
- increased growth velocity
- tall stature
其他诊断因素
- 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
危险因素
- 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
诊断性检查
首要检查
- 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
需考虑的检查
- 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
新兴检查
- overnight gonadotropin profile
治疗流程
central precocious puberty (CPP)
gonadotropin-independent precocious puberty (GIPP)
撰稿人
作者
Talat Mushtaq, BSc, MBCHB, MRCPCH, MD
Paediatric Endocrinology Consultant
Leeds Teaching Hospitals NHS Trust
Leeds
UK
利益声明
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
利益声明
SH has received speaking honoraria from Sandoz and Novo Nordisk.
鸣谢
Dr Talat Mushtaq and Dr Sasha Howard would like to gratefully acknowledge Dr Ameeta Mehta and Professor Peter Hindmarsh, previous contributors to this topic.
利益声明
AM and PH are authors of several references cited within this topic.
同行评议者
Malcolm Donaldson, MD, FRCP, FRCPCH, DCH
Senior Lecturer in Child Health
Department of Child Health
Royal Hospital for Sick Children
Glasgow
UK
利益声明
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
利益声明
PK declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969 Jun;44(235):291-303.全文 摘要
Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970 Feb;45(239):13-23.全文 摘要
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.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Premature thelarche
- Premature adrenarche
- Congenital adrenal hyperplasia (CAH)
更多 鉴别诊断Guidelines
- GnRH analogue stimulation testing to investigate precocious puberty
- Use of gonadotropin-releasing hormone analogs in children: update by an international consortium
更多 Guidelines
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