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.

Pubertad precoz

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 20 Aug 2025
Last updated: 23 May 2023

Summary

Definition

History and exam

Key diagnostic factors

  • presencia de factores de riesgo
  • chicos: testículos ≥4 mL
  • niñas: desarrollo mamario
  • vello púbico/axilar
  • menarquia
  • velocidad de crecimiento aumentada
  • estatura alta
Full details

Other diagnostic factors

  • manchas color café con leche
  • síntomas de otra hiperfunción endocrina autónoma
  • displasia fibrosa poliostótica
  • neurofibromas, pecas axilares y cifoescoliosis
  • dismorfia facial
  • clitoromegalia
  • alteraciones oculares
  • déficits motores
  • tamaño de cabeza anormal
Full details

Risk factors

  • tumores cerebrales
  • irradiación craneal
  • Síndrome de McCune-Albright
  • tumores gonadales
  • hiperplasia suprarrenal congénita (HSC)
  • antecedentes familiares positivos
  • exposición a hormonas exógenas
  • lesión en la cabeza
  • neurofibromatosis tipo 1
  • infecciones previas de sistema nervioso central
  • hidrocefalia
  • anomalías hipofisarias congénitas
  • adopción
  • abuso sexual
Full details

Diagnostic investigations

1st investigations to order

  • Etapas de Tanner
  • medición del tamaño testicular
  • evaluación de edad ósea
  • hormona foliculoestimulante (FSH) basal y hormona luteinizante (LH)
  • prueba de estimulación de la hormona liberadora de gonadotrofina (GnRH)
  • testosterona en suero
  • estrógenos séricos
  • ultrasonido de pelvis
Full details

Investigations to consider

  • imagen por resonancia magnética (IRM) cerebral
  • tomografía computarizada (TC) cerebral
  • 17-hidroxiprogesterona
  • perfil de esteroides en orina
  • prueba de estimulación con hormona adrenocorticotrópica (ACTH).
  • tomografía computarizada (TC) o imagen por resonancia magnética (IRM) de glándulas suprarrenales
  • ultrasonido de glándulas suprarrenales
  • gammagrafía ósea/examen del esqueleto
  • otras investigaciones de hormonas hipofisarias
  • pruebas genéticas
  • pruebas de función tiroidea
Full details

Emerging tests

  • perfil de gonadotropinas durante la noche

Treatment algorithm

ACUTE

pubertad precoz central (PPC)

pubertad precoz gonadotropina-independiente (PPGI)

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.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.
  • Pubertad precoz images

  • Differentials

    • Telarquia prematura
    • Adrenarquia prematura
    • Hiperplasia suprarrenal congénita (HSC)
    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