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



What is the incidence of 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 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 experience5-8: 

  • 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:

A focused medical history, including9:

  • 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 velocity10-12

A physical examination

Staging by using Tanner-Marshall protocol to evaluate pubertal development

Tanner-Marshall stage ≥2 before age of 8 in girls1

  • Evaluation of breast development: Palpitation helps differentiate breast tissue from adipose tissue13

Tanner-Marshall stage ≥2 before age of 9 in boys1

  • 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 suggestive1

Imaging studies


Left hand/wrist
x-ray to determine bone age9


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 boys15

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 to9:

  • Testosterone
  • Estradiol
  • Follicle-stimulating hormone 
  • Luteinizing hormone
  • Thyroid-stimulating hormone
  • Thyroxine
  • Human chorionic gonadotropin

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


Always check with parents or caregivers to ensure that the pediatric endocrinologist is routinely monitoring their child



How is CPP treated?

GnRH agonists are standard of care for treatment of CPP16,17

  • Since the 1980s, GnRH agonists have been used to suppress the HPG axis1,18
  • By desensitizing and downregulating GnRH receptors, GnRH agonists gradually inhibit gonadotropin release1,2,19

GnRH=gonadotropin-releasing hormone; HPG=hypothalamic-pituitary-gonadal.


Learn more about the efficacy of LUPRON DEPOT-PED for the treatment of CPP