Introduction

• True precocious puberty refers to breast development at age <8years in a girl or testicular enlargement ≥4ml at age <9years in a boy
• These children will often have tall stature and/or accelerating linear growth rate that is inconsistent with family heights
• It may be idiopathic, genetic or secondary to intracranial lesions, with intracranial pathology more common in males and those presenting at younger age
• Note chest wall adiposity can mimic breast development in females, and the investigations below can be useful in discriminating. 

If isolated pubic hair: please see referral guideline for premature adrenarche

When to refer

• Girls: evidence of breast development at age <8years
• Boys: evidence of testicular enlargement ≥4ml, or virilisation /development of phallus at age <9yrs
• Rapidly progressive early puberty

Initial work up (to assist with appropriate triaging)

• Thyroid function tests, FSH, LH and testosterone/oestradiol
• Bone age X-ray

Referral information needed

• Clinical history: age of onset, rate and degree of progression
• Height and weight (include date of assessment), and previous measurements with if available
• Parental heights and history on timing of parental puberty if possible
• Results of investigations
• Relevant previous medical history (eg any known structural brain lesion)

Contact information

• For clinical advice, the endocrinology fellow or endocrinologist on call can be contacted through the hospital switch board (03) 9345 5522
• Outpatient booking enquiry information (03) 9345 6180

Author

• Guideline developed by RCH Endocrinology Department