| Cause |
Clinical Features |
Investigations |
Management |
Central (True) Precocious Puberty
(e.g., Idiopathic, CNS Tumours) |
Early development of secondary sexual characteristics, growth acceleration, advanced bone age, headaches or visual disturbances if CNS tumour is present. |
Serum LH and FSH (elevated), MRI of the brain (to rule out CNS tumours), bone age assessment, pelvic ultrasound (in girls). |
GnRH analog therapy to delay further pubertal progression, monitoring growth and development, surgical resection if a CNS tumour is present. |
Peripheral (Precocious Pseudopuberty)
(e.g., McCune-Albright Syndrome, Adrenal Tumours) |
Asymmetric development of secondary sexual characteristics, café-au-lait spots (in McCune-Albright), virilization in girls, advanced bone age. |
Serum estradiol/testosterone (elevated), adrenal imaging (CT or MRI), bone age assessment, genetic testing for McCune-Albright syndrome. |
Treatment of the underlying cause (e.g., surgical removal of adrenal tumours), anti-estrogen or anti-androgen therapy, management of associated symptoms. |
| Congenital Adrenal Hyperplasia (CAH) |
Early development of pubic/axillary hair, rapid growth, virilization in girls, salt-wasting crisis in severe cases, advanced bone age. |
Serum 17-hydroxyprogesterone (elevated), serum electrolytes, genetic testing for CYP21A2 mutation, adrenal ultrasound. |
Glucocorticoid replacement therapy, mineralocorticoid replacement if salt-wasting form, monitoring of growth and development, surgical management of genital ambiguity if needed. |
| Gonadal Tumours |
Asymmetric breast development, rapid growth, early pubic hair, abdominal mass if gonadal tumour is present, virilization in girls or feminization in boys. |
Serum estradiol/testosterone (elevated), ultrasound or MRI of the pelvis, serum tumour markers (e.g., AFP, hCG), bone age assessment. |
Surgical resection of the tumour, chemotherapy or radiotherapy if indicated, monitoring for recurrence, hormone therapy if necessary. |
| Exogenous Hormone Exposure |
Early development of secondary sexual characteristics without other signs of puberty progression, exposure history to external hormones (e.g., creams, medications). |
Serum estradiol/testosterone (elevated), review of medication history, assessment for possible sources of hormone exposure. |
Discontinuation of exogenous hormone sources, education on avoiding exposure, monitoring for regression of pubertal signs. |
| Primary Hypothyroidism |
Delayed growth, precocious puberty, delayed bone age, goiter, symptoms of hypothyroidism (fatigue, constipation, weight gain). |
Serum TSH (elevated), free T4 (low), bone age assessment, thyroid ultrasound if goiter is present. |
Thyroid hormone replacement therapy (levothyroxine), monitoring for resolution of precocious puberty signs and normalization of growth. |
| Familial (Constitutional) |
Early but normal progression of puberty, family history of early puberty, normal growth velocity and bone age. |
Growth charts, family history assessment, bone age assessment, serum LH and FSH (normal). |
Reassurance and monitoring, no specific treatment needed, regular follow-up to ensure normal pubertal progression. |
