Precocious Puberty

Precocious puberty means secondary sexual characteristics begin before age 8 years in girls or before age 9 years in boys. The threshold identifies children who need evaluation; it does not, by itself, prove a specific cause. The experienced nurse looks for a pattern of progression rather than reacting to one isolated finding. Breast development, testicular or penile enlargement, pubic or axillary hair, body odour, acne, vaginal bleeding, or a rapid change in growth pattern may signal pubertal activation. A child who is steadily advancing through several changes and crossing upward on the growth chart needs a different response from a child with isolated breast tissue or isolated body odour that has not progressed. Central precocious puberty results from early activation of the hypothalamic–pituitary–gonadal axis. Pulsatile gonadotropin-releasing hormone stimulates pituitary luteinizing hormone and follicle-stimulating hormone, which then increase ovarian or testicular sex-steroid production. Peripheral precocious puberty produces sex-steroid effects without this coordinated central activation; possible sources include adrenal or gonadal disorders, exogenous hormones, or other endocrine pathology. The distinction matters because leuprolide treats central activation, not every cause of early sex-steroid...