Treatment of precocious puberty

Requires specialist assessment and management (1,2,3,4).

A review notes that (3):

• although there is a chance of finding pathology in girls with signs of puberty before 8 years of age and in boys before 9 years of age, the vast majority of these children with signs of apparent puberty have variations of normal growth and physical development and do not require laboratory testing, bone age radiographs, or intervention
• the most common of these signs of early puberty are premature adrenarche (early onset of pubic hair and/or body odor), premature thelarche (nonprogressive breast development, usually occurring before 2 years of age), and lipomastia, in which girls have apparent breast development which, on careful palpation, is determined to be adipose tissue
• indicators that the signs of sexual maturation may represent true, central precocious puberty include progressive breast development over a 4- to 6-month period of observation or progressive penis and testicular enlargement, especially if accompanied by rapid linear growth

Treatment depends on cause.

• gonadotrophin releasing hormone (GnRH) (gonadotrophin dependent precocious puberty or GDPP)
  • some girls with idiopathic gonadotrophin releasing hormone (GnRH) (gonadotrophin dependent precocious puberty or GDPP) (4)
    • may benefit from consideration of therapy with GnRH analogues, in order to prevent premature fusion of epiphyses and preserve adult height
      potential
    • benefits of GnRH analogue therapy are debated, however, and girls may be at risk of overtreatment
    • GnRH therapy has a role in preserving adult height potential in children with precocious puberty aged 6 and under
      • but for older children without rapidly progressing puberty, there is no evidence of any benefit (4)
        
        
• gonadotrophin releasing hormone (GnRH) (gonadotrophin independent precocious puberty or GIPP)
  
  • treatment of GIPP often more complex
    • depends on underlying cause

Reference:

• Muir A.Precocious puberty. Pediatr Rev 2006;27:373-81.
• Saenger P, Rincon M.Precocious puberty: McCune-Albright syndrome and beyond.J Pediatr. 2003 Jul;143(1):9-10.
• Kaplowitz P. Evaluation and Referral of Children With Signs of Early Puberty. Pediatrics 2016 Jan;137(1). doi: 10.1542/peds.2015-3732.
• Bradley S et al. Precocious puberty. BMJ. 2020 Jan 13;368:l6597