Early Signs of Pubertal Development

Abstract

Precocious puberty and precocious adrenarche are classically defined as onset of breast development or sexual hair growth in girls before age 8 years, or as onset of testicular enlargement to pubertal size or sexual hair growth in boys before age 9 years. These definitions are based on historical data in largely white, non-Hispanic populations, and timing of pubertal development may differ in children of different racial and ethnic groups as well as children with obesity. Although early pubertal development is most commonly a normal physiological variation in pubertal timing, careful evaluation is important to assess for the possibility of pathological causes including central nervous system tumors, peripheral estrogen- or androgen-secreting tumors, and certain genetic causes of precocious puberty, including McCune Albright syndrome, activating mutations of the luteinizing hormone receptor, and congenital adrenal hyperplasia. This chapter reviews the initial approach to children with early signs of puberty, focusing on history, physical examination, and initial laboratory and imaging evaluation.