What is precocious puberty?

The menarche, which is the first period, is the most obvious landmark in puberty tending to occur about 30 months after the first signs of breast development and is therefore seen at any time between 10 and 16.

Precocious puberty is diagnosed when puberty begins before the age of eight years or when the first period occurs before 10. It occurs far more frequently in girls than boys. Although thorough investigation including MRI (pelvic ultrasound) scans of the pituitary gland are required, no specific cause can usually be identified.

Rarely, one of the following may be found:

meningitis,

cerebral tumour^2006-01

McCune-Albright Syndrome recurrent ovarian cysts + cafe-au-lait irregular areas unilaterally.

Oestrogen - Secreting ovarian tumours (most benign)      

Exogenous oestrogen treatment

In the long-term, premature epiphyseal closure (the areas of bone growth) may occur leading to short stature.

The timing of menarche and the level of final height in Catalan girls with early onset of puberty was found to depend on prenatal growth. Girls with normal birth weight tend to progress slowly through puberty with a normal timing of menarche and normal final height. In contrast, girls with low birth weight tend to progress relatively rapidly to an early menarche and to a reduced final height.^2000-01 In SGA (small for gestational age - intrauterine growth retarded) girls, precocious puberty is associated with faster puberal development and shorter final height.

The link between prenatal growth restraint and early menarche has been extended to precocious puberty girls . ^2006-03The early growth acceleration pattern may be used as an additional clue to the diagnosis of idiopathic precocious puberty. ^2006-02

Girls with precocious pubarche (PP; pubic hair at<8 years of age) as a result of an early or amplified adrenarche (high dehydroepiandrosterone -sulfate [DHEAS]) tend to be hyperinsulinemic, in particular when born with low birth weight (LBW).^2006-05The efficacy of early metformin treatment in PP girls may be extended to include not only a less adipose body composition after 2 yr but also a less advanced onset of puberty, whereas height gain is maintained. Ultimately, metformin treatment may also prove to heighten the short adult stature of LBW-PP girls.^2006-04

A variety of drugs have been used to suppress precocious puberty; GnRH analogues (Q33.17) are currently the most favoured. Not all patients with apparent idiopathic precocious puberty require medical treatment, notably when there is no evidence of hypothalamo-pituitary ovarian activation or no significantly advanced BA to impair height potential. Most show a slowly progressing puberty. However, careful follow-up of these patients is necessary up to at least 9 years of age, because until then height prediction may deteriorate, necessitating gonadotropin-releasing hormone agonist treatment in one third of the cases.^2002-01

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