Precocious Puberty

The Challenge

The challenge is to evaluate patients who experience the normal events of puberty earlier than expected and to provide reassurance with appropriate or timely diagnosis and intervention when more sinister processes are at work. Precocious puberty is estimated to affect approximately 20/10,000 girls.

• Scope of the Problem: For all patients with precocious puberty (pubertal changes before the age of 7 years or cyclic menstruation before the age of 10 years, 2–2.5 standard deviations below the mean) the possibility of a serious process, either central or peripheral, must be evaluated. (Because of evolving changes in maturation rates, these traditional ages should be adjusted downward by 1 year for African-American girls.) Precocious puberty is customarily divided into two classifications: true or gonadotropin-releasing hormone (GnRH) dependent (70%) and precocious pseudopuberty that is independent of GnRH control. For most girls older than 4 years, no specific cause is discovered for early development. In contrast, the most common cause of precocious change in girls younger than 4 years is a central nervous system (CNS) lesion, most often hamartomas of the hypothalamus. Even when the sequence of events appears normal, a serious process (eg, a slowly progressing brain tumor) must be aggressively sought initially and watched for with long-term continuing observation. Patients also should be evaluated any time there is a disruption in the normal sequence of puberty or when there is patient or parental concern. Patients with significant abnormalities of either height or weight should be evaluated for chromosomal abnormalities or endocrinopathies.

• Objectives of Management: To establish the cause of delayed events of puberty with appropriate speed and care, without adding to the trauma of adolescence.