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Precocious Puberty

(Precocious Sexual Development, Premature Puberty)
  • Definition

    Precocious puberty is the unusually early onset of puberty. Typically, this is before:
    • Age 8 years in girls
    • Age 9 years in boys
  • Causes

    Puberty is a complex process of brain, body, and hormonal development. If your child begins puberty at an early age, it may just be a variation in the range of what is considered normal.
    In about 25%-75% of affected boys, this condition is due to underlying medical conditions. However, for many girls and some boys the cause is unknown.
    In rare cases, precocious puberty may be caused by conditions such as:
    • Congenital adrenal hyperplasia
    • McCune-Albright syndrome
    • Tumors or disorders of the testicles, ovaries, or adrenal gland
    • hCG-secreting tumors
    • Hypothalamic hamartoma (HH)—a rare benign brain tumor near the hypothalamus
    • Severe hypothyroidism
    Other causes:
    Abnormalities in Adrenal Glands or Hypothalamus May Lead to Precocious Puberty
    Kidney and adrenal
    Copyright © Nucleus Medical Media, Inc.
    Copyright © Nucleus Medical Media, Inc.
  • Risk Factors

    Precocious puberty is more common in girls, and in Black or Hispanic populations. Other factors that may increase your child's chance of precocious puberty include:
    • Family history—some cases may run in families
    • Head injury
    • Infection in brain
    • History of radiation therapy to the brain
    • Taking sex hormones
    • Some studies have suggested a link between obesity and premature puberty
  • Symptoms

    Symptoms of precocious puberty in girls may include:
    • Development of breasts, pubic hair, and underarm hair
    • Ovary enlargement
    • Cysts on ovaries
    • Menstrual bleeding
    Symptoms of precocious puberty in boys may include:
    • Growth of penis and testicles
    • Development of pubic and underarm hair
    • Muscle growth
    • Voice changes
    • Facial hair
    Symptoms in both boys and girls include:
    • Body odor
    • Acne
    • Behavior changes
    • Growth spurt
  • Diagnosis

    The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. An assessment of puberty milestones and growth will be done. Your child may be referred to an endocrinologist, a doctor who specializes in hormonal, glandular, and metabolic disorders.
    Imaging tests are used to evaluate bodily structures. These may include:
    Your child's bodily fluids may be tested. This can be done with blood tests.
  • Treatment

    Talk with your child's doctor about the best treatment plan. Treatment options include:
    Different medications can be used to treat precocious puberty depending on the type. These medications stop or slow sexual development. They also halt the rapid bone growth and encourage normal growth.
    Psychological Support
    Developing before their peers may cause social challenges in some children. Psychological support may be helpful. Talk to your child's doctor about what options are available.
    Treatment of Underlying Conditions
    If an underlying condition is the cause of precocious puberty, treatment will involve treating the specific medical problem.
    Surgery may be needed if the early puberty is caused by a tumor or other lesions. The procedure will depend on the location and size of the tumor.
    Ongoing Monitoring
    The doctor will continue to check your child’s height, weight, and sexual development. This will help to note any changes or show if the treatment has been effective.
  • Prevention

    There are no current guidelines to prevent precocious puberty.

    National Institute of Child Health and Human Development

    Nemours Kid's Health


    About Kid's Health—The Hospital for Sick Children

    Health Canada


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    Blondell RD, Foster MB, Kamlesh CD. Disorders of puberty. Am Fam Physician. 1999;60(1):209-218.

    Cesario SK, Hughes LA. Precocious puberty: A comprehensive review of literature. J Ob Gyn Neonatal Nurs. 2007;36(3):263-274.

    Himes JH, Obarzanek E, Baranowski T, et al. Early sexual maturation, body composition, and obesity in African-American girls. Obesity Research. 2004;12 Suppl:64S-72S.

    Papathanasiou A, Hadjiathanasiou C. Precocious puberty. Ped Endocr Rev. 2006;3:182-187.

    Precocious puberty. EBSCO DynaMed website. Available at: Updated July 3, 2013. Accessed July 16, 2013.

    Puberty and precocious puberty. National Institute of Child Health and Human Development website. Available at: Updated April 3, 2013. Accessed July 16, 2013.

    VN Brito, AC Latronico, Arnhold IJ, Mendonca BB. Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arq Bras Endrocrinol Metab. 2008; 52(1):18-31.

    Wang Y. Is obesity associated with early sexual maturation? A comparison of the association in American boys versus girls. Pediatrics. 2002;110(5):903-910.

    12/13/2010 DynaMed's Systematic Literature Surveillance Biro FM, Galvez MP, Greenspan LC, et al. Pubertal assessment method and baseline characteristics in a mixed longitudinal study of girls. Pediatrics. 2010;126(3):e583-e590.

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