Precocious puberty: a comprehensive review of diagnosis and clinical presentation, etiology, and treatment
Abstract
Central precocious puberty (CPP) is characterized by early activation of the hypothalamic-pituitary-gonadal (HPG) axis, which is apparent in the form of breast development in girls and testicular enlargement in boys prior to the typical physiological age ranges. Although intracranial pathology, exposure to high levels of sex steroids, or environmental risk factors can precipitate CPP, the majority of cases are idiopathic. Monogenic causes have also been identified. We provide a concise summary of the pathophysiology, risk factors, diagnosis, and management of CPP in this review. A referral to pediatric endocrinology should be initiated when there is concern for CPP. The diagnosis is confirmed through clinical, biochemical, radiological, and genetic testing. The primary objectives of administering a gonadotropin-releasing hormone (GnRH) analog to patients with CPP are to increase adult height and postpone the development of secondary sexual characteristics until a later age that is more compatible with peer norms. Although the long-term results of treatment with GnRH analogs are encouraging, further research is required to investigate the psychological impact of CPP.
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