DO YOU SUSPECT CENTRAL PRECOCIOUS PUBERTY?

 

It is important to recognize children with features consistent with Central Precocious Puberty (CPP) to promptly refer them to a pediatric endocrinologist for diagnosis and treatment1

 

INCIDENCE

What is the incidence of central precocious puberty (CPP)?

CPP, a gonadotropin-dependent precocious puberty, is a rare condition.2,3

central precocious puberty symptoms
central precocious puberty symptoms CPP

What are the causes of CPP?

  • CPP is caused by early activation of the hypothalamic-pituitary-gonadal (HPG) axis4
  • CPP is most often idiopathic in girls, while boys are more likely to have organic causes4

What are the potential health implications of CPP?

Children with CPP may experience:5-8

  • Expression of secondary sexual characteristics that are inconsistent with their age group
  • Rapid bone maturation that results in shorter predicted adult height

 

DIAGNOSIS

How is CPP diagnosed?

If signs of early puberty are seen by the patient’s family or family physician, a complete physical examination should be performed including:

Take a focused medical history, including:9

  • The precise rate and timing of growth
  • A history of secondary sexual characteristic development
  • Behavioral changes related to puberty
  • A family history

An accurate plotting of growth and evaluation of growth velocity10,11

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A Physical Examination

Staging by using Tanner-Marshall protocol to evaluate pubertal development1,2,13

Tanner-Marshall stage ≥2 before age of 8 in girls

  • Evaluation of breast development: Palpitation helps differentiate breast tissue from adipose tissue

Tanner-Marshall stage ≥2 before age of 9 in boys

  • Evaluation of testicular development: A phallus length of 2.5 cm or more in flaccid state, or testicular volume of 4 mL or more is suggestive

Imaging Studies

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Left hand/wrist x-ray to determine bone age1,9

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Cranial MRI

  • May identify effects of hypothalamic hamartomas, optic nerve gliomas, hydrocephalus, arachnoidal cysts, and hypothalamic irradiation. These causes can be found in approximately 20% of CPP cases in girls and 65% of cases in boys16
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Possible pelvic ultrasound in girls

  • May help rule out CPP by identifying ovarian cysts, which may be associated with McCune-Albright syndrome or peripheral precocious (pseudo-) puberty (PPP)1
  • Can enable comparison of ovarian and uterine sizes with reference levels. Increased ovarian volume may indicate CPP1,4

Laboratory Studies

The healthcare provider may perform ultra-sensitive hormonal assays to confirm the diagnosis of CPP, which include but are not limited to:9

  • Testosterone
  • Estradiol
  • Follicle-stimulating hormone (FSH)
  • Luteinizing hormone (LH)
  • Thyroid-stimulating hormone (TSH)
  •  
  • Thyroxine (T4)
  • Human chorionic gonadotropin (hCG)

The pediatric endocrinologist may also perform a GnRH stimulation test.2,9

TREATMENT

How is CPP treated?

GnRH agonists are standard of care for treatment of central precocious puberty (CPP)17

  • Since the 1980s, GnRH agonists have been used to suppress the hypothalamic-pituitary-gonadal (HPG) axis1
  • By desensitizing and downregulating GnRH receptors, GnRH agonists gradually inhibit gonadotropin release1,2,18
Always check with parents or caregivers to ensure that the pediatric endocrinologist is routinely monitoring their child
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Learn more about the efficacy of LUPRON DEPOT-PED for the treatment of CPP

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