Treatment of precocious puberty
- Jennifer Harrington, MBBS, PhD
Jennifer Harrington, MBBS, PhD
- Department of Pediatrics, University of Toronto
- Division of Endocrinology, Hospital for Sick Children
- Mark R Palmert, MD, PhD
Mark R Palmert, MD, PhD
- Department of Pediatrics, University of Toronto
- Division of Endocrinology, Hospital for Sick Children
- Section Editors
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
- William F Crowley, Jr, MD
William F Crowley, Jr, MD
- Section Editor — Female Reproductive Endocrinology
- Daniel K Podolsky Professor of Medicine
- Harvard Medical School
- Mitchell E Geffner, MD
Mitchell E Geffner, MD
- Section Editor — Pediatric Endocrinology
- Professor of Pediatrics
- Keck School of Medicine, University of Southern California
- Deputy Editors
- Alison G Hoppin, MD
Alison G Hoppin, MD
- Deputy Editor — Pediatrics
- Assistant Professor of Pediatrics, Part-time
- Harvard Medical School
- Kathryn A Martin, MD
Kathryn A Martin, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Endocrinology and Patient Education
- Assistant Professor of Medicine
- Harvard Medical School
Precocious puberty is traditionally defined as the onset of secondary sexual development before the age of eight years in girls and nine years in boys. Because of trends towards earlier pubertal development, some healthy girls will have breast or pubic hair development before this age, and extensive evaluation and treatment may not be required. If the evaluation leads to a diagnosis of progressive precocious puberty, treatment may be considered.
The treatment of precocious puberty, which depends upon the underlying cause, will be discussed in this topic. The definition, etiology, and evaluation of precocious puberty are reviewed separately. (See "Definition, etiology, and evaluation of precocious puberty".)
Precocious puberty can be classified based upon the underlying pathologic process.
●Central precocious puberty — Central precocious puberty (CPP, also known as gonadotropin-dependent precocious puberty or true precocious puberty) is caused by early maturation of the hypothalamic-pituitary-gonadal (HPG) axis. It is characterized by sequential maturation of breasts and pubic hair in girls, and of maturation of the testes, penis, and pubic hair in boys. The sexual characteristics are appropriate for the child's gender (isosexual). CPP is idiopathic in 80 to 90 percent of cases in girls, whereas intracranial lesions are detected in 40 to 75 percent of boys with CPP (table 1A). (See "Definition, etiology, and evaluation of precocious puberty", section on 'Causes of central precocious puberty (CPP)'.)
●Peripheral precocity — Peripheral precocity (also known as gonadotropin-independent precocious puberty or peripheral precocious puberty) is caused by excess secretion of sex hormones (estrogens or androgens) derived either from the gonads or adrenal glands, exogenous sources of sex steroids, or ectopic production of gonadotropins from a germ cell tumor (eg, human chorionic gonadotropin, hCG) (table 1B). We use the term precocity instead of puberty because puberty implies activation of the HPG axis, as occurs in CPP, whereas precocity refers only to the secondary sexual characteristics. Peripheral precocity is most commonly either isosexual (concordant with the child's gender), or contrasexual (with virilization of girls and feminization of boys), but can also present with both virilizing and feminizing features in rare cases. (See "Definition, etiology, and evaluation of precocious puberty", section on 'Causes of peripheral precocity'.)
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- TREATMENT FOR CPP
- Decision to treat
- Goals of treatment
- GnRH agonist therapy
- - Formulations and dosing
- - Monitoring
- - Treatment duration
- - Safety
- - Our approach
- TREATMENT FOR PERIPHERAL PRECOCITY
- General approach
- McCune-Albright syndrome
- - Girls
- - Boys
- Familial male-limited precocious puberty
- BENIGN OR NON-PROGRESSIVE PUBERTAL VARIANTS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS