Understanding precocious puberty in girls

Abstract

Key content Precocious puberty is defined as the development of secondary sexual characteristics before the age of 8 years in girls. It is divided into central (gonadotrophin‐dependent) precocious puberty and peripheral (gonadotrophin‐independent) precocious puberty. Variants of premature sexual development include isolated premature thelarche, premature pubarche and isolated premature menarche (menstruation without other signs of puberty). Possible consequences of precocious puberty include short adult stature due to premature epiphyseal closure and psychosocial problems. Gonadotrophin‐releasing hormone analogues are the mainstay of treatment for central precocious puberty. Treatment options vary for peripheral precocious puberty, depending on the underlying aetiology. These include aromatase inhibitors, anti‐estrogens, anti‐androgens and tumour resection. Combined consultation with or referral to a paediatric endocrinologist is indicated in all cases. Learning objectives To be aware of the normal development and milestones of puberty. To understand the aetiology and diagnostic evaluation of the girl with precocious puberty. To be aware of treatment modalities and multidisciplinary management. Ethical issues Should children with precocious puberty and severe brain dysfunction be given contraception and treated for behavioural problems on parental request?