precocious puberty - differentiation from benign forms of puberty

Last edited 01/2020 and last reviewed 04/2023

Precocious puberty requires differentiation from the benign forms of puberty (1). These include:

• Premature Thelarche:
• it is the premature unilateral or bilateral development of the breast tissue in girls between the age of 12 to 24 months
• there are no other associated pubertal changes. Bone age, growth velocity, and biochemical testing are normal
• it is usually a diagnosis of exclusion. Frequent clinical follow up to monitor growth, and pubertal progression is required

• Premature Adrenarche:
• the early production of adrenal androgens characterizes this benign condition. It presents with pubic or axillary hair, body odor, or acne before the age of 8 years
• there is no breast development in females and no testicular enlargement in males. Bone age is usually not advanced
• it is essential to rule out exposure to androgen sources such as creams or gels, adrenal tumors, and late-onset CAH

• Premature Menarche:
• isolated premature menarche is the onset of vaginal bleeding in girls less than 7 years of age
• they may present with either a single episode or few cycles (less than 3) of bleeding and have normal progression to puberty
• recent studies have suggested no effect on adult height
• sexual abuse, vaginal foreign body, and infections of the vulva and vagina need to be ruled out.

Reference:

• Kota AS, Ejaz S. Precocious Puberty. StatPearls November 2019.