Precocious puberty

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Última revisão: 1 Dec 2025

Última atualização: 28 Jan 2025

Precocious puberty should be considered when secondary sexual characteristics appear before 8 years of age in girls and 9 years in boys.

It results in accelerated bone development and sometimes a reduced adult height, and may have a psychosocial impact, especially due to early menses in girls.

Two forms exist: gonadotropin-dependent precocious puberty (known as central precocious puberty [CPP]; due to premature activation of the hypothalamo-pituitary-gonadal axis) and gonadotropin-independent precocious puberty (GIPP; due to autonomous secretion of sex steroids).

History should be directed dependent on whether puberty is consonant or disconsonant (i.e., whether the pattern of body changes are consistent with normal puberty or not).

Treatment of CPP is usually straightforward with gonadotropin-releasing hormone agonists.

GIPP is more difficult to treat, and may require medications to block production or action of sex steroids.

Treatment should be stopped once an acceptable age of puberty is reached.

Definição

Puberty is an interval characterized by acquisition of secondary sexual characteristics, accelerated linear growth, increase in the secretion of sex hormones, maturation of gonads (testes in boys; ovaries in girls), and the potential for reproduction. It is typically complete within 2 to 5 years. Precocious puberty should be considered when secondary sexual characteristics appear before 8 years in girls and 9 years in boys.[1][2] It also results in accelerated skeletal development with a reduced adult height.

História e exame físico

Principais fatores diagnósticos

boys: testes ≥4 mL
girls: breast development
pubic/axillary hair
menarche
increased growth velocity
tall stature

Detalhes completos

Outros fatores diagnósticos

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

Detalhes completos

Fatores de risco

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

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

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

Detalhes completos

Investigações a serem consideradas

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

Detalhes completos

Novos exames

overnight gonadotropin profile

Algoritmo de tratamento

AGUDA

central precocious puberty (CPP)

gonadotropin-independent precocious puberty (GIPP)

Colaboradores

Autores

Talat Mushtaq, BSc, MBCHB, MRCPCH, MD

Paediatric Endocrinology Consultant

Leeds Teaching Hospitals NHS Trust

Leeds

Declarações

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

Declarações

SH has received speaking honoraria from Sandoz and Novo Nordisk.

Agradecimentos

Dr Talat Mushtaq and Dr Sasha Howard would like to gratefully acknowledge Dr Ameeta Mehta and Professor Peter Hindmarsh, previous contributors to this topic.

Declarações

AM and PH are authors of several references cited within this topic.

Revisores

Malcolm Donaldson, MD, FRCP, FRCPCH, DCH

Senior Lecturer in Child Health

Department of Child Health

Royal Hospital for Sick Children

Glasgow

Declarações

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

Declarações

PK declares that he has no competing interests.

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child. 1969 Jun;44(235):291-303.Texto completo Resumo

Marshall WA, Tanner JM. Variations in the pattern of pubertal changes in boys. Arch Dis Child. 1970 Feb;45(239):13-23.Texto completo Resumo

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.Texto completo Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Premature thelarche
- Premature adrenarche
- Congenital adrenal hyperplasia (CAH)
Mais Diagnósticos diferenciais
Diretrizes
- GnRH analogue stimulation testing to investigate precocious puberty
- Use of gonadotropin-releasing hormone analogs in children: update by an international consortium
Mais Diretrizes
Conectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal

Precocious puberty

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

central precocious puberty (CPP)

gonadotropin-independent precocious puberty (GIPP)

Colaboradores

Autores

​Talat Mushtaq, ​BSc, MBCHB, MRCPCH, MD

Declarações

​Sasha Howard, MBBS, MRCPCH, MSc, PhD

Declarações

Agradecimentos

Declarações

Revisores

Malcolm Donaldson, MD, FRCP, FRCPCH, DCH

Declarações

Paul Kaplowitz, MD, PhD

Declarações

Créditos aos pareceristas

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice

Talat Mushtaq, BSc, MBCHB, MRCPCH, MD

Sasha Howard, MBBS, MRCPCH, MSc, PhD