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Primary Care Liaison

Precocious puberty

  • 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


    • Guideline developed by RCH Endocrinology Department