When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Precocious puberty

Last reviewed: 21 Oct 2024
Last updated: 23 May 2023

Summary

Definition

History and exam

Key diagnostic factors

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

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
Full details

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
Full details

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
Full details

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
Full details

Emerging tests

  • overnight gonadotropin profile

Treatment algorithm

ACUTE

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.

  • Precocious puberty images
  • Differentials

    • Premature thelarche
    • Premature adrenarche
    • Congenital adrenal hyperplasia (CAH)
    More Differentials
  • Guidelines

    • GnRH analogue stimulation testing to investigate precocious puberty
    • Use of gonadotropin-releasing hormone analogs in children: update by an international consortium
    More Guidelines
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer