Intended for healthcare professionals

Practice Practice Pointer

Precocious puberty

BMJ 2020; 368 doi: (Published 13 January 2020) Cite this as: BMJ 2020;368:l6597
  1. Stephen H Bradley, research fellow, general practitioner12,
  2. Neil Lawrence, paediatric trainee ST23,
  3. Caroline Steele, consultant paediatric endocrinologist4,
  4. Zainaba Mohamed, consultant paediatric endocrinologist5
  1. 1Academic Unit of Primary Care, University of Leeds, Leeds, UK
  2. 2York Street Practice, Leeds, UK
  3. 3Sheffield Children’s Hospital, Sheffield, UK
  4. 4Leeds Children’s Hospital, Leeds, UK
  5. 5Birmingham Children’s Hospital, Birmingham, UK
  1. Correspondence to Z Mohamed, zainaba.mohamed{at}

What you need to know

  • Thelarche and increased growth velocity before age 8 in girls and genital development in boys before age 9 suggests precocious puberty

  • Precocious puberty in boys represents a substantial risk of underlying pathology and requires urgent referral to a paediatric endocrinologist

  • Many cases of precocious puberty in girls over 6 have benign causes, but precocious puberty can indicate serious pathology in some cases

  • Precocious puberty can be hard for patients and families to discuss. Invite them to share their concerns

  • Timely referral is important to ensure children can benefit from treatment for precocious puberty, but be clear with patients about the uncertainty over benefits and harms from investigation and treatment

A 7 year old girl presents with history of body odour. She is tall for her age and her mother reports noticeable breast development and pubic hair growth over the last six months. The girl’s height is between the 75th and 91st centiles. Her mother recalls that her own periods began at age 11.

What is precocious puberty?

Puberty is the process of maturation that occurs during adolescence and includes acquisition of secondary sexual characteristics, rapid bone maturation, and acceleration of growth.

Precocious puberty is commonly defined as puberty that starts before age 8 in girls and 9 in boys.1 Most cases of precocious puberty in girls are idiopathic and the benefits of early identification and treatment are subject to much debate.23 Precocious puberty in boys is less common, but proportionally much more likely to have a serious cause.3 This Practice Pointer, aimed at non-specialists such as general practitioners, outlines the epidemiology of precocious puberty and describes features that warrant urgent referral or investigation. The article briefly considers the possible benefits of treatment versus the risks of over-medicalisation of idiopathic precocious puberty in girls, in cases where pathological causes are less …

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