referral criteria from primary care - precocious puberty
Precocious puberty is commonly defined as puberty that starts before age 8 in girls and 9 in boys (1).
GPs should have a low threshold for specialist referral in cases of suspected precocious puberty (2) - so if precocious puberty is suspected then this requires prompt referral for specialist review.
Red flags for urgent referral of suspected precocious puberty have been detailed (2) - these are not stated as necessary prerequisites for specialist referral; but are presentations/contexts which emphasise need for urgent specialist referrral. If precocious puberty is suspected (red flags present or not) then this is an indication for GP referral for specialist review:
Red Flags for Urgent Specialist Review (2,3,4)
A review states 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 (GDPP) 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
- many cases of precocious puberty in girls over 6 have benign causes - however precocious puberty can indicate serious pathology in some cases
- " Idiopathic" precocious puberty is the commonest cause of GDPP and is more commonly seen in girls than boys
- Muir A.Precocious puberty. Pediatr Rev 2006;27:373-81.
- Bradley S et al. Precocious puberty.BMJ. 2020 Jan 13;368:l6597
- Kaplowitz P. Evaluation and Referral of Children With Signs of Early Puberty. Pediatrics 2016 Jan;137(1). doi: 10.1542/peds.2015-3732.
- Kota AS, Ejaz S. Precocious Puberty. StatPearls November 2019.
Last edited 01/2020 and last reviewed 03/2020