Precocious Puberty Treatment & Management

Updated: Nov 30, 2020
  • Author: Paul B Kaplowitz, MD, PhD; Chief Editor: Robert P Hoffman, MD  more...
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Treatment

Approach Considerations

Early onset of puberty can lead to several problems. The early growth spurt initially can result in tall stature, but rapid bone maturation can cause linear growth to cease too early and may result in short adult stature. Moreover, the early appearance of breasts or menses in girls and increased libido in boys can cause emotional distress for some children. However, not all patients with CPP who are age 7 years or older at the time of onset require treatment.

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Surgical Care

When CPP is caused by a CNS tumor other than a hamartoma, a resection should be attempted to the extent possible without impinging on vital structures such as the optic nerves. Radiation therapy is often indicated if surgical resection is incomplete. Unfortunately, removal of the tumor rarely causes regression of precocious puberty.

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Medical Care

Patients treated with GnRH agonists

For patients with precocious puberty treated with GnRH agonists:

  • Follow up every 4-6 months to ensure that progression of puberty has been arrested
  • Favorable signs include normalization of accelerated growth, reduction (or at least no increase) in breast size, and suppression of gonadotropin levels after a challenge of GnRH
  • The ideal testing frequency has not been established, although one approach is to obtain a GnRH test about 4 months after starting the drug to confirm suppression and then conduct such testing no more often than yearly, as long as clinical indicators suggest that the drug is working as intended; some clinicians advocate dispensing with formal GnRH testing as long as growth has slowed and breasts have decreased in size; in boys, a decrease in the size of the testes and a fall in the serum testosterone level to less than 20 ng/dL are good indications of efficacy
  • Monitor bone age yearly to confirm that the rapid advancement seen in the untreated state has slowed, typically to a half year of bone age per year or less

A literature review by Wang et al found that the addition of growth hormone to GnRH agonist therapy resulted in significant height increase, as well as increases in predicted adult height and height standard deviation for bone age, in children with CPP. Efficacy was greater in patients whose initial treatment began prior to age 10 years or whose therapy lasted more than 12 months. [45]  However, the high cost of combined growth hormone–GnRH agonist therapy relative to its modest benefit has generally limited its use to children with a very poor adult height prediction.

Patients not treated with GnRH agonists

In many cases, the physician may elect to observe the child with CPP, either because the age of onset is borderline (ie, 7-8 y) and the child and family are coping well, or because the progression of puberty is not rapid and the bone age is only mildly advanced, so that predicted adult height falls well within the broad normal range. In these cases, thoughtful counseling of parents about the manageable risks of withholding treatment and follow-up at 6-month intervals are appropriate. [46] Testing and treatment may be initiated if the tempo of puberty begins to accelerate and predicted adult height deteriorates.

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