What is the incidence of central precocious puberty (CPP)?
CPP, a gonadotropin-dependent precocious puberty, is a rare condition.2,3
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
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
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
Left hand/wrist x-ray to determine bone age1,9
- 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
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
The healthcare provider may perform ultra-sensitive hormonal assays to confirm the diagnosis of CPP, which include but are not limited to:9
- Follicle-stimulating hormone (FSH)
- Luteinizing hormone (LH)
- Thyroid-stimulating hormone (TSH)
- Thyroxine (T4)
- Human chorionic gonadotropin (hCG)
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