Introduction

This guideline relates to precocious puberty in paediatric patients.

• 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. 

Note: 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

Referral criteria/required information

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

How to refer

RCH Specialist Clinics Referral.pdf

Please complete the above and submit via:

• Fax (03) 9345 5034 or
• Email screferrals@rch.org.au
• Urgent referral or clinical query call ED admitting officer, endocrinology fellow or endocrinologist on-call (03) 9345 5522

Suggested pre-referral work-up/management 

• Blood sampling:
  • Thyroid function tests
  • FSH
  • LH
  • Testosterone/oestradiol
• Bone age X-ray

Acknowledgements

The development of this guideline was coordinated by the Department of Endocrinology. Guideline reviewed in July 2025.