Approach to the Patient: Central Precocious Puberty

Abstract

Central precocious puberty (CPP) classically refers to premature activation of the hypothalamic pituitary- gonadal (HPG) axis with onset of sexual development before the age of 8 years in girls and 9 years in boys. A decrease in the age of thelarche has been reported over the past several decades; however, the tempo of pubertal progression can be slower and adult height may not be adversely affected in many of the girls who experience thelarche at 6-8 years. Outside of this secular trend in the development itself, the past several decades have also brought about advances in diagnosis and management. This includes the wide-spread use of ultrasensitive LH assay, decreasing the need for stimulation testing and a better understanding of the genetics that govern the onset of puberty. Additionally, management of central precocious puberty (CPP) using gonadotropin-releasing hormone analogs (GnRHa) has changed with the advent of new longer-acting formulations. Emerging long-term outcomes of GnRHa administration with regards to obesity, cardiovascular risk factors and fertility are reassuring. Despite these advancements, clinical care in CPP is hampered by the lack of well-designed controlled studies, and management decisions are frequently not supported by clear practice guidelines. Data in boys with CPP are limited and this article focuses on the diagnosis and management of CPP in girls, particularly, in those who present with thelarche at the age of 6-8 years.

Central Precocious Puberty in a Chinese Girl with cblC-Type Methylmalonic Acidemia: a case report

“…The administration of rhGH 0.6 IU/(kg.w) in neonates with MMA could improve skin erosion and shorten the length of hospital stay [30] . For children with CPP, previous studies reported that GnRHa and rhGH combination therapy is the best treatment option to improve the standard deviation of height and predicted adult height [31][32][33][34][35] . For our MMA patient, impaired adult height was predicted due to CPP.…”