pediatrics
Precocious Puberty
Key Points
Precocious puberty is the onset of sexual maturation before the average age based on population standards. Most commonly, secondary sexual characteristics develop prematurely because the hypothalamic-pituitary axis is activated (GnRH-dependent precocious puberty); often the cause is idiopathic, but some children have a central nervous system tumor. Less commonly, the cause is high circulating levels ofestrogensor androgens (GnRH-independent precocious puberty) caused by congenital adrenal hyperplasia or various gonadal tumors. Diagnosis is made by bone age x-rays and measurement of LH, FSH,testosterone(in boys), andestradiol(in girls). Treat GnRH-dependent precocious puberty with the GnRH agonistsleuprolideorhistrelin. Treat GnRH-independent precocious puberty based on the cause, including giving androgen orestrogenantagonists and removing tumors. 