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Definition, etiology, and evaluation of precocious puberty

Jennifer Harrington, MBBS, PhD
Mark R Palmert, MD, PhD
Section Editors
Peter J Snyder, MD
William F Crowley, Jr, MD
Mitchell E Geffner, MD
Deputy Editors
Alison G Hoppin, MD
Kathryn A Martin, MD


Precocious puberty is the onset of pubertal development at an age that is 2 to 2.5 standard deviations (SD) earlier than population norms. The cause of precocious puberty may range from a variant of normal development (eg, isolated premature adrenarche or isolated premature thelarche) to pathologic conditions with significant risk of morbidity and even death (eg, malignant germ-cell tumor and astrocytoma).

The clinician faced with a child who presents with early development of secondary sexual characteristics should consider the following questions:

Is the child too young to have reached the pubertal milestone in question? – To answer this question, the clinician needs to know the normal ages for pubertal milestones and how to separate normal from abnormal development.

What is causing the early development? – To answer this question, the physician ascertains whether the development of secondary sexual characteristics is attributable to androgen and/or estrogen effects, and whether the source of sex hormone is centrally mediated through the hypothalamic-pituitary-gonadal axis, from an autonomous peripheral origin, or has an exogenous basis.

Is therapy indicated, and, if so, what therapy?

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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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