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Pediatric Precocious Puberty

What is precocious puberty (early puberty)?

Abnormally early puberty is called precocious puberty and is characterized by the early development of sexual characteristics in girls before the age of 8 and in boys before the age of 9. Most children with the disorder grow fast at first, but also finish growing before reaching their full genetic height potential. Left untreated, most boys will not grow taller than 5 feet 2 inches, and girls often do not grow taller than 5 feet.

What causes precocious puberty?

Early puberty and sexual development may be caused by tumors or growths of the ovaries, adrenal glands, pituitary gland, or brain. Other causes may include central nervous system abnormalities, family history of the disease, or certain rare genetic syndromes. In many cases, no cause can be found for the disorder. Two types of precocious puberty include the following:

  • Gonadotropin-dependent precocious puberty, also known as central precocious puberty, this form of precocious puberty is the most common, affecting most girls with the disorder and half of boys with the disorder. The puberty is triggered by the premature secretion of gonadotropins (hormones responsible for puberty). Researchers believe that the premature maturation of the hypothalamus-pituitary-ovaries axis causes this disorder in girls. However, in the majority of cases, no cause for the early secretion of gonadotropin hormones can be found.
  • Gonadotropin-independent precocious puberty-this is a form of precocious puberty that is not triggered by the early release of gonadotropin hormones.

What are the symptoms of precocious puberty?

The following are the most common symptoms of precocious puberty. However, each child may experience symptoms differently. As in normal puberty, symptoms of precocious puberty include the onset of secondary sexual characteristics.

  • Girls:
    • Breasts
    • Pubic and underarm hair
    • Menstruation
    • Ovulation
  • Boys:
    • Enlarging penis and testicles
    • Pubic and underarm hair
    • Facial hair
    • Spontaneous erections
    • Production of sperm
    • Development of acne
    • Deepening of the voice

Other characteristics of the disorder include:

  • Typical moodiness associated with the hormonal changes
  • Increased aggression
  • Taller than peers, at first

How is precocious puberty diagnosed?

In addition to a complete medical history and physical examination of your child, diagnosis of precocious puberty may include:

  • X-ray
  • Measurement of gonadotropins (LH and FSH), estradiol, testosterone, and/or thyroid hormones
  • Ultrasoundof the adrenal glands and gonads (ovaries and testes)
  • Gonadotropin-stimulating hormone (GnRH) stimulation test (produced by the hypothalamus to stimulate the pituitary gland to release gonadotropins, which, in turn, stimulate the production of sex hormones in the gonads) to determine the form of precocious puberty (gonadotropin-dependent or gonadotropin-independent)
  • Magnetic resonance imaging (MRI)


Specific treatment for precocious puberty will be determined by your child's physician based on:

  • Your child's age, overall health, and medical history
  • Extent of the condition
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Opinion or preference

The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of early puberty symptoms. Treatment will also depend on the type of precocious puberty and the underlying cause, if known.

New developments in hormone treatments for precocious puberty have led to the successful use of synthetic luteinizing-releasing hormone (LHRH). This synthetic hormone appears to stop the sexual maturation process brought on by the disorder by halting the pituitary gland from releasing the gonadotropin hormones.

What is the emotional effect of precocious puberty on a child?

Early puberty will cause a child's body to change much sooner than his/her peers. This sense of being different, coupled with the hormonal change-induced emotional mood swings, may make a child feel self-conscious. Your child may feel uncomfortable about his/her sexual changes, as well. Helping your child cope with teasing from his/her peers, treating your child appropriately for his/her age, and boosting your child's self-esteem are important steps to help your child adjust more appropriately.



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