Materiały źródłowe

• #1 Disorders of Puberty: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p590.html

  Precocious puberty is pubertal onset before eight years of age in girls and before nine years of age in boys. […] History and physical examination should be followed by measurements of serum follicle-stimulating hormone, luteinizing hormone, and testosterone (boys) or estradiol (girls); thyroid function testing; and bone age radiography. […] Brain magnetic resonance imaging should be performed in girls younger than six years, all boys with precocious puberty, and children with neurologic symptoms. […] Precocious puberty is diagnosed when secondary sexual characteristics are identified in girls younger than eight years and boys younger than nine years. […] The initial workup should include measurement of serum FSH, LH, and testosterone in boys or estradiol in girls; thyroid function testing; and bone age radiography.

• #2 Precocious Puberty – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544313/

  Precocious puberty is an early onset of puberty and secondary sexual characteristics in children. It is a very challenging diagnosis as the differential varies from benign variants to serious conditions such as malignancy. This activity reviews the early identification, evaluation, and management of precocious puberty and highlights the role of providers in identifying the condition and promptly referring to the pediatric endocrinologist for further management and preventing the complications. […] The traditional definition of precocious puberty is the development of secondary sexual characteristics before 8 years of age in girls and 9 years in boys. […] Initial screening tests usually include bone age, measurement of LH, FSH Testosterone, Dehydroepiandrosterone sulfate (DHEA-S), 17 OH progesterone levels, and thyroid function tests.

• #3

  https://www.lupronpedpro.com/do-you-suspect-central-precociouspuberty.html

  It is important to recognize children with features consistent with Central Precocious Puberty (CPP) to promptly refer them to a pediatric endocrinologist for diagnosis and treatment. […] How is CPP diagnosed? […] If signs of early puberty are seen by the patient’s family or family physician, a complete physical examination should be performed, including: A focused medical history, including: The precise rate and timing of growth, A history of secondary sexual characteristic development, Behavioral changes related to puberty, A family history. […] An accurate plotting of growth and evaluation of growth velocity. […] A physical examination. […] Staging by using Tanner-Marshall protocol to evaluate pubertal development. […] Tanner-Marshall stage 2 before age of 8 in girls. […] Tanner-Marshall stage 2 before age of 9 in boys.

• #4 SciELO Brazil – Central precocious puberty: revisiting the diagnosis and therapeutic management Central precocious puberty: revisiting the diagnosis and therapeutic management

  https://www.scielo.br/j/aem/a/Tpzrbb9PdZR7FcnkJw7C69f/?lang=en

  The clinical history must always be the initial diagnostic step, and investigation should include the birth conditions, history of perinatal trauma, previous infections, accidental ingestion of drugs, and use of creams or ointments. […] The physical examination must include information about height, weight, and pubertal stage. […] It is essential to discriminate between CPP and common variants of precocious puberty, such as isolated premature thelarche or adrenarche and prepubertal vaginal bleeding due or not to a hormonal etiology. […] Laboratory measurement of gonadotropins (mainly LH) at baseline and/or after stimulation with short-acting GnRH is recommended to document the activation of the gonadal axis. […] Although a basal LH value in the prepubertal range does not exclude the diagnosis of CPP, GnRH stimulation test is not warranted in most cases.

• #5 How do healthcare providers diagnose precocious puberty & delayed puberty? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/puberty/conditioninfo/diagnosed

  To identify whether a child is entering puberty, a pediatrician (a physician specializing in the treatment of children) will carefully examine the following: […] After giving a child a complete physical examination and analyzing his or her medical history, a healthcare provider may perform tests to diagnose precocious puberty, including: […] A blood test to check the level of hormones, such as the gonadotropins (luteinizing hormone [LH] and follicle-stimulating hormone [FSH]), estradiol, testosterone, dehydroepiandrosterone sulfate (DHEAS), and thyroid hormones. […] A gonadotropin-releasing hormone agonist (GnRHa) stimulation test, which can tell whether a child’s precocious puberty is gonadotropin-dependent or gonadotropin-independent. […] Measuring blood 17-hydroxyprogesterone to test for congenital adrenal hyperplasia.

• #6 Precocious Early Puberty | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/precocious-early-puberty

  When a child enters puberty (the process of becoming sexual mature) too early, it’s called precocious puberty, or early puberty. Children experiencing the condition develop early sexual characteristics; in girls this means before age 8, and in boys, this means before age 9. […] The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of puberty. At Children’s, we often use synthetic luteinizing-hormone-releasing hormone (LHRH). […] In addition to a complete medical history and physical examination of your child, diagnosis of precocious puberty may include: measurement of important hormones including gonadotropins (LH and FSH), estradiol, testosterone and/or thyroid hormones. […] The goal of treatment for precocious puberty is to stop, and possibly reverse, the onset of puberty. Treatment will also depend on the type of precocious puberty and the underlying cause, if known.

• #7 Precocious Puberty Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/924002-workup

  If the history, physical examination, and laboratory data suggest that a child exhibits early and sustained pubertal maturation, the clinician must differentiate CPP from precocious pseudopuberty. In CPP, which is gonadotropin-dependent, early maturation of the entire hypothalamic-pituitary-gonadal (HPG) axis occurs, with the full spectrum of physical and hormonal changes of puberty. Precocious pseudopuberty is much less common and refers to conditions in which increased production of sex steroids is gonadotropin-independent. Correct diagnosis of the etiology of sexual precocity is critical because the evaluation and treatment of patients with precocious pseudopuberty are quite different from those of patients with CPP. […] Measurement of serum testosterone is useful in boys with suspected precocious puberty. Early morning testosterone levels in boys in early puberty are higher than afternoon levels because luteinizing hormone (LH) and testosterone levels rise with sleep onset in early puberty.

• #8 Precocious Puberty: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/924002-overview

  Because of the development of more sensitive third-generation assays for luteinizing hormone (LH), which can detect levels as low as 0.1 IU/L or lower, random LH is now considered a good screening test for CPP, with levels of 0.3 IU/L or above considered diagnostic. […] Measurement of serum testosterone is useful in boys with suspected precocious puberty. […] When used to determine bone age, radiography of the hand and wrist is a quick and helpful means of estimating the likelihood of precocious puberty and its speed of progression. […] If the history, physical examination, and laboratory data suggest that a child exhibits early and sustained evidence of pubertal maturation, the clinician must differentiate CPP from precocious pseudopuberty. […] Correct diagnosis of the etiology of sexual precocity is critical because the evaluation and treatment of patients with precocious pseudopuberty are quite different from those of patients with CPP.

• #9 How do healthcare providers diagnose precocious puberty & delayed puberty? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/puberty/conditioninfo/diagnosed

  To identify whether a child is entering puberty, a pediatrician (a physician specializing in the treatment of children) will carefully examine the following: […] After giving a child a complete physical examination and analyzing his or her medical history, a healthcare provider may perform tests to diagnose precocious puberty, including: […] A blood test to check the level of hormones, such as the gonadotropins (luteinizing hormone [LH] and follicle-stimulating hormone [FSH]), estradiol, testosterone, dehydroepiandrosterone sulfate (DHEAS), and thyroid hormones. […] A gonadotropin-releasing hormone agonist (GnRHa) stimulation test, which can tell whether a child’s precocious puberty is gonadotropin-dependent or gonadotropin-independent. […] Measuring blood 17-hydroxyprogesterone to test for congenital adrenal hyperplasia.

• #10 Disorders of Puberty: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p590.html

  Precocious puberty is pubertal onset before eight years of age in girls and before nine years of age in boys. […] History and physical examination should be followed by measurements of serum follicle-stimulating hormone, luteinizing hormone, and testosterone (boys) or estradiol (girls); thyroid function testing; and bone age radiography. […] Brain magnetic resonance imaging should be performed in girls younger than six years, all boys with precocious puberty, and children with neurologic symptoms. […] Precocious puberty is diagnosed when secondary sexual characteristics are identified in girls younger than eight years and boys younger than nine years. […] The initial workup should include measurement of serum FSH, LH, and testosterone in boys or estradiol in girls; thyroid function testing; and bone age radiography.

• #11 Precocious puberty – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/1127

  Precocious puberty should be considered when secondary sexual characteristics appear before 8 years of age in girls and 9 years in boys. […] History should be directed dependent on whether puberty is consonant or disconsonant (i.e., whether the pattern of body changes are consistent with normal puberty or not). […] Key diagnostic factors include presence of risk factors, boys: testes 4 mL, girls: breast development, pubic/axillary hair, menarche, increased growth velocity, and tall stature. […] 1st investigations to order include Tanner staging, measurement of testicular size, bone age assessment, basal follicle-stimulating hormone (FSH) and luteinising hormone (LH), gonadotrophin-releasing hormone (GnRH) stimulation test, serum testosterone, serum oestrogen, and ultrasound pelvis. […] Investigations to consider include MRI brain, CT brain, 17-hydroxyprogesterone, urinary steroid profile, adrenocorticotropic hormone (ACTH) stimulation test, CT or MRI adrenals, ultrasound adrenals, bone scan/skeletal survey, other pituitary hormone investigations, genetic testing, and thyroid function tests. […] Emerging tests include overnight gonadotrophin profile.

• #12 Precocious puberty – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/precocious-puberty/diagnosis-treatment/drc-20351817

  Diagnosing precocious puberty involves: […] Running blood tests to measure hormone levels. […] X-rays of children’s hands and wrists also are helpful in diagnosing precocious puberty. These X-rays can show if the bones are growing too quickly. […] A test called a gonadotropin-releasing hormone (GnRH) stimulation test helps identify the type of precocious puberty. […] Children with peripheral precocious puberty need more testing to find the cause of their condition. This might include more blood tests to check hormone levels or, in girls, an ultrasound to check for an ovarian cyst or tumor.

• #13 Precocious Puberty Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/924002-workup

  Because of the development of more sensitive third-generation assays for LH, which can detect levels as low as 0.1 IU/L or below, random LH is now considered a good screening test for CPP, with levels of 0.3 IU/L or above considered diagnostic. However, many children with CPP have prepubertal basal LH levels but will respond to a challenge with GnRH with an increase to 5 IU/L or above, which is considered pubertal. […] A definitive diagnosis of CPP may be confirmed by measuring LH and FSH levels 30-60 minutes after stimulation with GnRH at 100 mcg or with a GnRH analogue. […] Thyroid tests are not a routine requirement in the evaluation of precocious puberty. Mild to moderate hypothyroidism does not lead to early puberty, and severe hypothyroidism only rarely does, in a phenomenon known as Van Wyk-Grumbach syndrome.

• #14 Central Precocious Puberty: How It’s Diagnosed

  https://www.webmd.com/parenting/diagnosing-central-precocious-puberty

  Doctors know how to treat central precocious puberty (CPP), an early start of puberty that affects one in every 5,000-10,000 kids. But before they can treat it, your pediatrician and other health care professionals have to make sure that your child has it. […] Often, the cause of CPP is unknown. But experts think it can be the result of an injury or other issue with your child’s brain. That problem forces the brain to send signals to your child’s body to secrete hormones that prompt puberty. […] A physical exam will follow, and then probably some tests. Those tests can include: […] Maybe the most important test to determine if a child has CPP is the gonadotropin releasing hormone (GnRH) stimulation test. The doctor will put an IV in your child’s arm. They’ll use it to give medicine, and also to take blood samples at different intervals after the medicine. The medication, called leuprolide (Lupron Depot), helps the doctor figure out if your child’s body is making hormones prematurely.

• #15 Evaluation of the diagnostic value of different serum biomarkers in girls with central precocious puberty | Egyptian Pediatric Association Gazette | Full Text

  https://epag.springeropen.com/articles/10.1186/s43054-024-00291-1

  Alarming trends show an increase in referrals of girls with suspected early puberty. […] GnRH stimulation test is the gold standard diagnostic test, which is expensive and challenging to interpret. […] Therefore, we sought to evaluate the diagnostic performance of basal serum Luteinizing Hormone and Anti-Mullerian hormone in girls with central precocious puberty, as an easier alternative to GnRH stimulation test. […] The diagnosis and management of PP constitute a major challenge. […] To distinguish between different categories of PP, the GnRH stimulation test (GnRHST), which evaluates peak luteinizing hormone (LH) after GnRH agonist stimulation, is still recognized as the gold standard test. […] Therefore, there is an unmet clinical need to search for simple affordable biomarkers such as serum LH and AMH that could overcome the disadvantages of GnRHST and evaluate their performance in diagnosing CPP in girls.

• #16 Evaluation of the diagnostic value of different serum biomarkers in girls with central precocious puberty | Egyptian Pediatric Association Gazette | Full Text

  https://epag.springeropen.com/articles/10.1186/s43054-024-00291-1

  The gold standard test for diagnosing CPP is intravenous GnRHST which confirms the premature activation of HPG axis. […] However, this test is time-consuming and expensive as it requires repeated blood sampling. […] Previous studies have suggested basal serum LH as the most sensitive biomarker to differentiate between CPP and premature thelarche, rendering it suitable as a substitute for GnRHST. […] Therefore, we propose that basal LH0.29 IU/L could be used as a better discriminator for children with CPP. […] From the present study, we can conclude that basal LH levels at a cut-off point of0.29 were superior to FSH and AMH as a suitable screening test to detect CPP, which could save time and expenses by potentially limiting the need to perform GnRHST. […] Furthermore, AMH cannot be used as screening test in patients with CPP.

• #17 Precocious Puberty Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/924002-workup

  Because of the development of more sensitive third-generation assays for LH, which can detect levels as low as 0.1 IU/L or below, random LH is now considered a good screening test for CPP, with levels of 0.3 IU/L or above considered diagnostic. However, many children with CPP have prepubertal basal LH levels but will respond to a challenge with GnRH with an increase to 5 IU/L or above, which is considered pubertal. […] A definitive diagnosis of CPP may be confirmed by measuring LH and FSH levels 30-60 minutes after stimulation with GnRH at 100 mcg or with a GnRH analogue. […] Thyroid tests are not a routine requirement in the evaluation of precocious puberty. Mild to moderate hypothyroidism does not lead to early puberty, and severe hypothyroidism only rarely does, in a phenomenon known as Van Wyk-Grumbach syndrome.

• #18

  https://link.springer.com/article/10.1007/s12020-024-03781-9

  To identify cut-off for basal LH levels and for pelvic ultrasound uterine and ovarian parameters indicating an HypotalamicPituitaryGonadal (HPG) axis activation as diagnostic of Central Precocious Puberty (CPP). […] A single basal LH measurement under the cut-off limit may be adequate to exclude an HPG axis activation as CPP. […] The gold standard for detecting HPG axis activation is to measure the maximal LH level after a GnRH stimulation test. […] The GnRH stimulation test is the gold standard for diagnosing CPP since it has almost 100% specificity despite its low sensitivity. […] For these reasons, many authors over the years have investigated the possible role of gonadotropins basal levels in CPP diagnosis. […] In our study, we identified 0.14mIU/mL as the best cut-off point for basal LH, with a sensitivity of 90.6% and a specificity of 78.2%.

• #19 Clinical Management and Therapy of Precocious Puberty in the Sapienza University Pediatrics Hospital of Rome, Italy

  https://www.mdpi.com/2227-9067/10/10/1672

  Initial laboratory investigations should include serum gonadotropin (LH and FSH) levels and sex steroids, estradiol in girls and testosterone in boys. Baseline LH > 0.3 mIU/mL is considered diagnostic for central precocious puberty; however, values below this limit do not exclude the diagnosis and require further diagnostic investigations. […] In the diagnostic process of suspected precocious puberty, it is important to exclude an unknown and therefore untreated hypothyroidism condition, mainly if there is slow instead of rapid growth and clear hypothyroid signs and symptoms. Initial evaluation of the child with suspected precocious puberty should include the assessment of bone age, because children with precocious puberty frequently have advanced bone age, greater than two SDs of chronological age.

• #20 Evaluation of the diagnostic value of different serum biomarkers in girls with central precocious puberty | Egyptian Pediatric Association Gazette | Full Text

  https://epag.springeropen.com/articles/10.1186/s43054-024-00291-1

  The gold standard test for diagnosing CPP is intravenous GnRHST which confirms the premature activation of HPG axis. […] However, this test is time-consuming and expensive as it requires repeated blood sampling. […] Previous studies have suggested basal serum LH as the most sensitive biomarker to differentiate between CPP and premature thelarche, rendering it suitable as a substitute for GnRHST. […] Therefore, we propose that basal LH0.29 IU/L could be used as a better discriminator for children with CPP. […] From the present study, we can conclude that basal LH levels at a cut-off point of0.29 were superior to FSH and AMH as a suitable screening test to detect CPP, which could save time and expenses by potentially limiting the need to perform GnRHST. […] Furthermore, AMH cannot be used as screening test in patients with CPP.

• #21

  https://link.springer.com/article/10.1007/s12020-024-03781-9

  To identify cut-off for basal LH levels and for pelvic ultrasound uterine and ovarian parameters indicating an HypotalamicPituitaryGonadal (HPG) axis activation as diagnostic of Central Precocious Puberty (CPP). […] A single basal LH measurement under the cut-off limit may be adequate to exclude an HPG axis activation as CPP. […] The gold standard for detecting HPG axis activation is to measure the maximal LH level after a GnRH stimulation test. […] The GnRH stimulation test is the gold standard for diagnosing CPP since it has almost 100% specificity despite its low sensitivity. […] For these reasons, many authors over the years have investigated the possible role of gonadotropins basal levels in CPP diagnosis. […] In our study, we identified 0.14mIU/mL as the best cut-off point for basal LH, with a sensitivity of 90.6% and a specificity of 78.2%.

• #22 Differential diagnosis of precocious puberty in girls during the COVID-19 pandemic: a pilot study | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-04009-x

  The GnRH stimulation test was performed in patients with breast development and LH0.10.2 IU/L. CPP was diagnosed when the peak value of LH was greater than 5.0 U/L, and the LH/FSH ratio was greater than 0.6. […] Our study demonstrated that LH, uterine volume, follicle numbers and BA exhibited important differences between IPT and CPP. […] Patients with LH exceeding 0.285 IU/L and more than 4 follicles were more likely to have CPP. […] Our study proposes that girls with LH above 0.285 IU/L should further undergo the GnRH stimulation test to confirm CPP diagnosis, greatly reducing stimulation numbers and alleviating medical burdens. […] In summary, the prevalence of overweight and obesity in girls with precocious puberty during the COVID-19 pandemic was high. […] Basal serum LH levels and follicle numbers are important indexes for the differential diagnosis of CPP. […] PAH was impaired in CPP patients, but it was not impaired in IPT patients.

• #23 How do healthcare providers diagnose precocious puberty & delayed puberty? | NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development

  http://www.nichd.nih.gov/health/topics/puberty/conditioninfo/diagnosed

  A „bone age” Xray to determine if bones are growing at a normal rate. […] The healthcare provider may also use imaging techniques to rule out a tumor or other organ abnormality as a cause. These imaging methods may include: […] Ultrasound (sonography) to examine the gonads. […] An MRI (magnetic resonance imaging) scan of the brain and pituitary gland using an instrument that produces detailed images of organs and bodily structures.

• #24 Precocious Puberty Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/924002-workup

  As used to determine bone age, radiography of the hand and wrist is a quick and helpful means of estimating the likelihood of precocious puberty and its speed of progression. […] Many authors have recommended that a brain MRI be performed to look for a tumor or a hamartoma in any child after hormonal studies indicate a diagnosis of CPP. […] Ultrasonography is unnecessary for girls with a definite diagnosis of CPP. If performed, however, ultrasonography usually reveals bilaterally enlarged ovaries, often with multiple small follicular cysts, and an enlarged uterus with an endometrial stripe. […] If CPP is caused by a tumor in the hypothalamic-pituitary area, the histology of the tumor can be important to the patient’s prognosis.

• #25 Precocious Puberty – Pediatrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pediatrics/endocrine-disorders-in-children/precocious-puberty

  Precocious puberty is onset of sexual maturation before the average age. Diagnosis is by comparison with population standards, x-rays of the left hand and wrist to assess skeletal maturation and check for accelerated bone growth, and measurement of serum levels of gonadotropins and gonadal and adrenal steroids. […] Diagnosis of precocious puberty is clinical. X-rays of the left hand and wrist are done to check for accelerated skeletal maturation as a result of sex hormone effect. […] Diagnosis is made by bone age x-rays and measurement of LH and testosterone (in boys), and estradiol (in girls).

• #26 Precocious Puberty – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544313/

  Bone age is an initial screening test. If the bone age is advanced (greater than two standard deviations) than the chronologic age, further testing should follow. Hormonal testing differentiates peripheral and central causes. A baseline prepubertal LH level of greater than 0.3 IU/L is suggestive of CPP. Levels under 0.3 are indicative of peripheral causes or benign variants. […] The decision to treat depends on the age of the child and the progression of puberty. If the child has rapidly progressing symptoms or if bone age is significantly advanced, consider treatment. The main goals of treatment are to preserve the adult height and to alleviate the associated psychosocial stress. […] Precocious puberty requires differentiation from the benign forms of puberty.

• #27 Disorders of Puberty: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p590.html

  Precocious puberty is pubertal onset before eight years of age in girls and before nine years of age in boys. […] History and physical examination should be followed by measurements of serum follicle-stimulating hormone, luteinizing hormone, and testosterone (boys) or estradiol (girls); thyroid function testing; and bone age radiography. […] Brain magnetic resonance imaging should be performed in girls younger than six years, all boys with precocious puberty, and children with neurologic symptoms. […] Precocious puberty is diagnosed when secondary sexual characteristics are identified in girls younger than eight years and boys younger than nine years. […] The initial workup should include measurement of serum FSH, LH, and testosterone in boys or estradiol in girls; thyroid function testing; and bone age radiography.

• #28 2022 Clinical practice guidelines for central precocious puberty of Korean children and adolescents

  https://e-apem.org/journal/view.php?number=994

  […] KQ 3. When should a brain MRI be performed to identify organic causes in patients with CPP? […] Recommendation 3-1. Brain MRI is recommended for girls younger than 6 years of age who have been diagnosed with CPP, and for girls older than 6 years who have neurologic signs and symptoms suggesting a CNS abnormality (Randomized controlled study. Do, Strong) […] Recommendation 3-2. Brain MRI is selectively considered for girls with an onset of puberty between the age of 6 and 8 years who have no neurological signs or symptoms suspicious of CNS abnormality (Nonrandomized controlled study. Do, Conditional) […] Recommendation 3-3 Brain MRI is recommended for boys diagnosed with CPP (Nonrandomized controlled study. Do, Conditional). […] […] KQ 4. What are the indications and considerations for treatment in patients with CPP? […] Recommendation 4-1. An observation period of 3 to 6 months is recommended to evaluate the tempo of pubertal progression in patients with suspected CPP (Randomized controlled study. Do, Strong) […] Recommendation 4-2. Treatment is recommended for rapid progressive-precocious puberty (Randomized controlled study. Do, Strong) […] Recommendation 4-3. Treatment is considered for girls with CPP that are at high risk for psychosocial stress due to early menarche (Nonrandomized controlled study. Do, Conditional).

• #29 Disorders of Puberty: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p590.html

  Precocious puberty is pubertal onset before eight years of age in girls and before nine years of age in boys. […] History and physical examination should be followed by measurements of serum follicle-stimulating hormone, luteinizing hormone, and testosterone (boys) or estradiol (girls); thyroid function testing; and bone age radiography. […] Brain magnetic resonance imaging should be performed in girls younger than six years, all boys with precocious puberty, and children with neurologic symptoms. […] Precocious puberty is diagnosed when secondary sexual characteristics are identified in girls younger than eight years and boys younger than nine years. […] The initial workup should include measurement of serum FSH, LH, and testosterone in boys or estradiol in girls; thyroid function testing; and bone age radiography.

• #30 Precocious Puberty Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/924002-workup

  As used to determine bone age, radiography of the hand and wrist is a quick and helpful means of estimating the likelihood of precocious puberty and its speed of progression. […] Many authors have recommended that a brain MRI be performed to look for a tumor or a hamartoma in any child after hormonal studies indicate a diagnosis of CPP. […] Ultrasonography is unnecessary for girls with a definite diagnosis of CPP. If performed, however, ultrasonography usually reveals bilaterally enlarged ovaries, often with multiple small follicular cysts, and an enlarged uterus with an endometrial stripe. […] If CPP is caused by a tumor in the hypothalamic-pituitary area, the histology of the tumor can be important to the patient’s prognosis.

• #31 Precocious Puberty (Pediatric) | ColumbiaDoctors

  https://www.columbiadoctors.org/treatments-conditions/precocious-puberty-pediatric

  The following diagnostic tests may also help in diagnosis: X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist to estimate your child’s bone age. With precocious puberty, bone age is often older than calendar age. […] Ultrasound (sonography). This imaging test uses sound waves and a computer to create pictures of blood vessels, tissues, and organs. It helps physicians evaluate the uterus and ovaries. […] Magnetic Resonance Imaging (MRI). This test uses a large magnets and a computer to make detailed images of tissues in the body.

• #32 Precocious Puberty Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/924002-workup

  As used to determine bone age, radiography of the hand and wrist is a quick and helpful means of estimating the likelihood of precocious puberty and its speed of progression. […] Many authors have recommended that a brain MRI be performed to look for a tumor or a hamartoma in any child after hormonal studies indicate a diagnosis of CPP. […] Ultrasonography is unnecessary for girls with a definite diagnosis of CPP. If performed, however, ultrasonography usually reveals bilaterally enlarged ovaries, often with multiple small follicular cysts, and an enlarged uterus with an endometrial stripe. […] If CPP is caused by a tumor in the hypothalamic-pituitary area, the histology of the tumor can be important to the patient’s prognosis.

• #33 Disorders of Puberty: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p590.html

  Precocious puberty is pubertal onset before eight years of age in girls and before nine years of age in boys. […] History and physical examination should be followed by measurements of serum follicle-stimulating hormone, luteinizing hormone, and testosterone (boys) or estradiol (girls); thyroid function testing; and bone age radiography. […] Brain magnetic resonance imaging should be performed in girls younger than six years, all boys with precocious puberty, and children with neurologic symptoms. […] Precocious puberty is diagnosed when secondary sexual characteristics are identified in girls younger than eight years and boys younger than nine years. […] The initial workup should include measurement of serum FSH, LH, and testosterone in boys or estradiol in girls; thyroid function testing; and bone age radiography.

• #34 2022 Clinical practice guidelines for central precocious puberty of Korean children and adolescents

  https://e-apem.org/journal/view.php?number=994

  The Committee of Central Precocious Puberty of Korean Pediatrics and Adolescents of the Korean Society of Pediatric Endocrinology has newly developed evidence-based 2022 clinical practice guidelines for central precocious puberty in Korean children and adolescents. […] This review summarizes the newly revised guidelines into 8 key questions and 27 recommendations and consists of 4 sections: screening, diagnosis, treatment, and long-term outcome of central precocious puberty. […] […] KQ 2. What tests are performed to diagnose CPP and how are they interpreted? […] Recommendation 2-1. BA measurement is recommended for the diagnosis of CPP (Nonrandomized controlled study. Do, Strong) […] Recommendation 2-2. GnRH stimulation test is recommended for the diagnosis of CPP (Nonrandomized controlled study. Do, Strong) […] Recommendation 2-3. Unstimulated LH measurement can be considered an auxiliary method for the diagnosis of CPP (Nonrandomized controlled study. Do, Conditional) […] Recommendation 2-4. Pelvic ultrasonography can be considered an auxiliary tool for the diagnosis of CPP (Randomized controlled study. Do, Conditional) […] Recommendation 2-5. Breast ultrasonography is not recommended for the diagnosis of CPP (Expert opinion. Do not, Strong).

• #35 Differential diagnosis of precocious puberty in girls during the COVID-19 pandemic: a pilot study | BMC Pediatrics | Full Text

  https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-04009-x

  To investigate the differential diagnosis of girls aged 6 to 8 years with idiopathic premature thelarche (IPT) and central precocious puberty (CPP) during the COVID-19 pandemic. […] Logistic regression analysis showed that LH and follicle numbers were independent risk factors for CPP. […] The ROC curve showed that the area under the curve (AUC) of LH and follicle numbers were 0.823 and 0.697. […] Basal LH above 0.285 IU/L and follicle numbers greater than 4 were important features suggestive of CPP. […] Auxological data should not be used in the differential diagnosis of IPT and CPP. […] The diagnostic criteria for CPP in girls were as follows: (1) Breast development before 8 years; (2) Linear growth acceleration; (3) Advanced bone age by more than one year; (4) Uterine and ovary enlargement and multiple follicles with diameters greater than 4 mm; and (5) Hypothalamic-pituitary-gonadal axis activation.

• #36 Clinical Management and Therapy of Precocious Puberty in the Sapienza University Pediatrics Hospital of Rome, Italy

  https://www.mdpi.com/2227-9067/10/10/1672

  Puberty identifies the transition from childhood to adulthood. Precocious puberty is the onset of signs of pubertal development before age eight in girls and before age nine in boys, it has an incidence of 1/5000–1/10,000 with an F:M ratio ranging from 3:1 to 20:1. […] In the suspicion of early sexual maturation, it is important to collect information regarding the age of onset, the speed of maturation of secondary sexual features, exposure to exogenous sex steroids and the presence of neurological symptoms. The objective examination, in addition to the evaluation of secondary sexual characteristics, must also include the evaluation of auxological parameters. Initial laboratory investigations should include serum gonadotropin levels (LH and FSH) and serum levels of the sex steroids. […] Regardless of the cause, PP must be promptly recognized since it is associated with accelerated stature growth and skeletal maturation if untreated, inducing an early growth arrest with premature epiphyseal fusion due to excess sex steroids, which sometimes results in short adult height. The key features suggesting PP are the progressive development of breasts in girls and testicular volume in boys over a short period of observation (3–6 months) associated with rapid height growth (height velocity >6–7 cm/year) especially in girls aged between 6 and 8 years, when this condition occurs more frequently.

• #37 Precocious Puberty Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/924002-workup

  If the history, physical examination, and laboratory data suggest that a child exhibits early and sustained pubertal maturation, the clinician must differentiate CPP from precocious pseudopuberty. In CPP, which is gonadotropin-dependent, early maturation of the entire hypothalamic-pituitary-gonadal (HPG) axis occurs, with the full spectrum of physical and hormonal changes of puberty. Precocious pseudopuberty is much less common and refers to conditions in which increased production of sex steroids is gonadotropin-independent. Correct diagnosis of the etiology of sexual precocity is critical because the evaluation and treatment of patients with precocious pseudopuberty are quite different from those of patients with CPP. […] Measurement of serum testosterone is useful in boys with suspected precocious puberty. Early morning testosterone levels in boys in early puberty are higher than afternoon levels because luteinizing hormone (LH) and testosterone levels rise with sleep onset in early puberty.

• #38 Pathology is key in diagnosing peripheral precocious puberty

  https://www.contemporarypediatrics.com/view/pathology-is-key-in-diagnosing-peripheral-precocious-puberty

  Pathology is key in diagnosing peripheral precocious puberty. […] Diagnosis of peripheral precocious puberty can be made when there is breast development that occurs without the activation of the HPG axis, or when there is penile growth with or without the development of pubic hair and without testicular enlargement. […] Kutney said normally you would not see significant virilization of the external genitalia without testicular enlargement, so if this is the case, its usually a red flag to some sort of pathology.

• #39 Precocious Puberty

  https://elsevier.health/en-US/preview/precocious-puberty-co

  Diagnosis is made based on laboratory and radiographic findings. […] The first step in evaluating precocious puberty is to measure first morning serum luteinizing hormone, follicle-stimulating hormone, and sex steroid (estrogen or testosterone) levels. […] If any baseline laboratory test results are already in pubertal range, the next step is an imaging study. […] If baseline laboratory test results (ie, luteinizing hormone, follicle-stimulating hormone, and estradiol or testosterone) are within reference range, the next step is stimulation testing. […] Findings consistent with central and peripheral precocious puberty include pubertal levels of follicle-stimulating hormone, luteinizing hormone, and sex hormones and pubertal luteinizing hormone response to gonadotropin-releasing hormone stimulation test. […] The findings most consistent with peripheral precocious puberty include high levels of sex hormones (estrogen or testosterone) accompanied by low levels of gonadotropins.

• #40 SciELO Brazil – Central precocious puberty: revisiting the diagnosis and therapeutic management Central precocious puberty: revisiting the diagnosis and therapeutic management

  https://www.scielo.br/j/aem/a/Tpzrbb9PdZR7FcnkJw7C69f/?lang=en

  The clinical history must always be the initial diagnostic step, and investigation should include the birth conditions, history of perinatal trauma, previous infections, accidental ingestion of drugs, and use of creams or ointments. […] The physical examination must include information about height, weight, and pubertal stage. […] It is essential to discriminate between CPP and common variants of precocious puberty, such as isolated premature thelarche or adrenarche and prepubertal vaginal bleeding due or not to a hormonal etiology. […] Laboratory measurement of gonadotropins (mainly LH) at baseline and/or after stimulation with short-acting GnRH is recommended to document the activation of the gonadal axis. […] Although a basal LH value in the prepubertal range does not exclude the diagnosis of CPP, GnRH stimulation test is not warranted in most cases.

• #41 SciELO Brazil – Central precocious puberty: revisiting the diagnosis and therapeutic management Central precocious puberty: revisiting the diagnosis and therapeutic management

  https://www.scielo.br/j/aem/a/Tpzrbb9PdZR7FcnkJw7C69f/?lang=en

  The clinical history must always be the initial diagnostic step, and investigation should include the birth conditions, history of perinatal trauma, previous infections, accidental ingestion of drugs, and use of creams or ointments. […] The physical examination must include information about height, weight, and pubertal stage. […] It is essential to discriminate between CPP and common variants of precocious puberty, such as isolated premature thelarche or adrenarche and prepubertal vaginal bleeding due or not to a hormonal etiology. […] Laboratory measurement of gonadotropins (mainly LH) at baseline and/or after stimulation with short-acting GnRH is recommended to document the activation of the gonadal axis. […] Although a basal LH value in the prepubertal range does not exclude the diagnosis of CPP, GnRH stimulation test is not warranted in most cases.

• #42 Clinical Management and Therapy of Precocious Puberty in the Sapienza University Pediatrics Hospital of Rome, Italy

  https://www.mdpi.com/2227-9067/10/10/1672

  Puberty identifies the transition from childhood to adulthood. Precocious puberty is the onset of signs of pubertal development before age eight in girls and before age nine in boys, it has an incidence of 1/5000–1/10,000 with an F:M ratio ranging from 3:1 to 20:1. […] In the suspicion of early sexual maturation, it is important to collect information regarding the age of onset, the speed of maturation of secondary sexual features, exposure to exogenous sex steroids and the presence of neurological symptoms. The objective examination, in addition to the evaluation of secondary sexual characteristics, must also include the evaluation of auxological parameters. Initial laboratory investigations should include serum gonadotropin levels (LH and FSH) and serum levels of the sex steroids. […] Regardless of the cause, PP must be promptly recognized since it is associated with accelerated stature growth and skeletal maturation if untreated, inducing an early growth arrest with premature epiphyseal fusion due to excess sex steroids, which sometimes results in short adult height. The key features suggesting PP are the progressive development of breasts in girls and testicular volume in boys over a short period of observation (3–6 months) associated with rapid height growth (height velocity >6–7 cm/year) especially in girls aged between 6 and 8 years, when this condition occurs more frequently.

• #43 2022 Clinical practice guidelines for central precocious puberty of Korean children and adolescents

  https://e-apem.org/journal/view.php?number=994

  […] KQ 3. When should a brain MRI be performed to identify organic causes in patients with CPP? […] Recommendation 3-1. Brain MRI is recommended for girls younger than 6 years of age who have been diagnosed with CPP, and for girls older than 6 years who have neurologic signs and symptoms suggesting a CNS abnormality (Randomized controlled study. Do, Strong) […] Recommendation 3-2. Brain MRI is selectively considered for girls with an onset of puberty between the age of 6 and 8 years who have no neurological signs or symptoms suspicious of CNS abnormality (Nonrandomized controlled study. Do, Conditional) […] Recommendation 3-3 Brain MRI is recommended for boys diagnosed with CPP (Nonrandomized controlled study. Do, Conditional). […] […] KQ 4. What are the indications and considerations for treatment in patients with CPP? […] Recommendation 4-1. An observation period of 3 to 6 months is recommended to evaluate the tempo of pubertal progression in patients with suspected CPP (Randomized controlled study. Do, Strong) […] Recommendation 4-2. Treatment is recommended for rapid progressive-precocious puberty (Randomized controlled study. Do, Strong) […] Recommendation 4-3. Treatment is considered for girls with CPP that are at high risk for psychosocial stress due to early menarche (Nonrandomized controlled study. Do, Conditional).

• #44 Disorders of Puberty: An Approach to Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1101/p590.html

  Precocious puberty is pubertal onset before eight years of age in girls and before nine years of age in boys. […] History and physical examination should be followed by measurements of serum follicle-stimulating hormone, luteinizing hormone, and testosterone (boys) or estradiol (girls); thyroid function testing; and bone age radiography. […] Brain magnetic resonance imaging should be performed in girls younger than six years, all boys with precocious puberty, and children with neurologic symptoms. […] Precocious puberty is diagnosed when secondary sexual characteristics are identified in girls younger than eight years and boys younger than nine years. […] The initial workup should include measurement of serum FSH, LH, and testosterone in boys or estradiol in girls; thyroid function testing; and bone age radiography.

• #45 Precocious Puberty Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/924002-workup

  As used to determine bone age, radiography of the hand and wrist is a quick and helpful means of estimating the likelihood of precocious puberty and its speed of progression. […] Many authors have recommended that a brain MRI be performed to look for a tumor or a hamartoma in any child after hormonal studies indicate a diagnosis of CPP. […] Ultrasonography is unnecessary for girls with a definite diagnosis of CPP. If performed, however, ultrasonography usually reveals bilaterally enlarged ovaries, often with multiple small follicular cysts, and an enlarged uterus with an endometrial stripe. […] If CPP is caused by a tumor in the hypothalamic-pituitary area, the histology of the tumor can be important to the patient’s prognosis.

• #46

  https://www.lupronpedpro.com/do-you-suspect-central-precociouspuberty.html

  Imaging studies. […] Left hand/wrist x-ray to determine bone age. […] Cranial MRI may identify effects of hypothalamic hamartomas, optic nerve gliomas, hydrocephalus, arachnoidal cysts, and hypothalamic irradiation. […] Possible pelvic ultrasound in girls may help rule out CPP by identifying ovarian cysts, which may be associated with McCune-Albright syndrome or peripheral precocious (pseudo-) puberty (PPP). […] The healthcare provider may perform ultra-sensitive hormonal assays to confirm the diagnosis of CPP, which include but are not limited to: Testosterone, Estradiol, Follicle-stimulating hormone, Luteinizing hormone, Thyroid-stimulating hormone, Thyroxine, Human chorionic gonadotropin. […] The pediatric endocrinologist may also perform a GnRH stimulation test.

• #47

  https://www.lupronpedpro.com/do-you-suspect-central-precociouspuberty.html

  Imaging studies. […] Left hand/wrist x-ray to determine bone age. […] Cranial MRI may identify effects of hypothalamic hamartomas, optic nerve gliomas, hydrocephalus, arachnoidal cysts, and hypothalamic irradiation. […] Possible pelvic ultrasound in girls may help rule out CPP by identifying ovarian cysts, which may be associated with McCune-Albright syndrome or peripheral precocious (pseudo-) puberty (PPP). […] The healthcare provider may perform ultra-sensitive hormonal assays to confirm the diagnosis of CPP, which include but are not limited to: Testosterone, Estradiol, Follicle-stimulating hormone, Luteinizing hormone, Thyroid-stimulating hormone, Thyroxine, Human chorionic gonadotropin. […] The pediatric endocrinologist may also perform a GnRH stimulation test.

• #48 Precocious Puberty (Pediatric) | ColumbiaDoctors

  https://www.columbiadoctors.org/treatments-conditions/precocious-puberty-pediatric

  The following diagnostic tests may also help in diagnosis: X-ray. This test uses a small amount of radiation to make images of tissues inside the body. An X-ray may be done of the left hand and wrist to estimate your child’s bone age. With precocious puberty, bone age is often older than calendar age. […] Ultrasound (sonography). This imaging test uses sound waves and a computer to create pictures of blood vessels, tissues, and organs. It helps physicians evaluate the uterus and ovaries. […] Magnetic Resonance Imaging (MRI). This test uses a large magnets and a computer to make detailed images of tissues in the body.

• #49 Development and Validation of Clinical Diagnostic Model for Girls with Central Precocious Puberty: Machine-learning Approaches | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261965

  A brief gonadotropin-releasing hormone analogues (GnRHa) stimulation test which solely focused on LH 30-minute post-stimulation was considered to identify girls with central precocious puberty (CPP). […] We aimed to develop a machine learning-based diagnostic model that processed baseline CPP-related variables and a brief GnRHa stimulation test for CPP diagnosis. […] Girls received a CPP diagnosis if they exhibited the following criteria: (a) onset of secondary sexual characteristics including breast development and/or pubic hair development at age 8 years and (b) peak LH level 5 IU/L combined with a ratio of peak LH to FSH value 0.6 after GnRHa stimulation test. […] The model was achieved according to the highest performance metric of F1-score (0.976) and a high AUC value (0.972). […] Our finding indicates the trend of CPP diagnosis using a machine learning-based model that helps make a better diagnosis than traditional methods.

• #50 A Diagnostic Scoring System to Distinguish Precocious Puberty from Premature Thelarche based on Clinical and Laboratory Findings

  https://brieflands.com/articles/ijp-64118

  The aim of this study was to design a new diagnostic scoring system based on clinical and laboratory findings to distinguish precocious puberty (PP) from premature thelarche (PT) among girls diagnosed with early puberty. […] A diagnostic scoring system, based on clinical and laboratory findings can be an alternative or complementary method for the differential diagnosis of early puberty. […] The differential diagnosis of precocious puberty (PP) from premature thelarche (PT) and its variants sometimes poses diagnostic dilemma. […] Scoring systems are commonly used to diagnose or predict progress in many diseases and also provide a simple and systematic approach for inexperienced junior staff clinicians. […] A diagnostic scoring system could contribute to distinguish equivocal cases of PP and PT and also provide a simpler alternative to current methods for use by clinicians who are faced with making decisions on cases of early puberty.

• #51

  https://www.healio.com/news/endocrinology/20170912/urinary-gonadotropin-levels-aid-precocious-puberty-diagnosis

  Urinary gonadotropin levels increased shortly before the onset of puberty among girls and boys, according to researchers in Denmark. […] Researchers wrote that the findings may aid in the diagnosis and management of disordered puberty in children. […] The GnRH stimulation test, considered the gold standard for diagnosing pubertal disorders, is a procedure that requires hospitalization and only few normative data for GnRH-stimulated values exist. […] As an alternative, noninvasive method for evaluating the function of the hypothalamic-pituitary-gonadal hormone axis, measurement of the gonadotropin concentrations in first morning voided urine has been proposed. […] Urinary gonadotropin levels rose as the children aged, the researchers reported, and were detectable in first morning voided urine before children began showing signs of puberty.

• #52

  https://www.healio.com/news/endocrinology/20170912/urinary-gonadotropin-levels-aid-precocious-puberty-diagnosis

  Urinary LH was better for differentiating childrens pubertal stage than FSH, Kolby and colleagues wrote. […] Our data suggest that first morning voided urinary concentrations of LH can be used as a diagnostic marker in girls suspected of central precocious puberty, the researchers wrote. […] In addition, we suggest measurement of unadjusted first morning voided urinary concentrations of LH as a method for monitoring treatment with GnRH agonists in girls with central precocious puberty.

• #53 A Diagnostic Scoring System to Distinguish Precocious Puberty from Premature Thelarche based on Clinical and Laboratory Findings

  https://brieflands.com/articles/ijp-64118

  The aim of this study was to design a new diagnostic scoring system based on clinical and laboratory findings to distinguish precocious puberty (PP) from premature thelarche (PT) among girls diagnosed with early puberty. […] A diagnostic scoring system, based on clinical and laboratory findings can be an alternative or complementary method for the differential diagnosis of early puberty. […] The differential diagnosis of precocious puberty (PP) from premature thelarche (PT) and its variants sometimes poses diagnostic dilemma. […] Scoring systems are commonly used to diagnose or predict progress in many diseases and also provide a simple and systematic approach for inexperienced junior staff clinicians. […] A diagnostic scoring system could contribute to distinguish equivocal cases of PP and PT and also provide a simpler alternative to current methods for use by clinicians who are faced with making decisions on cases of early puberty.

• #54 A Diagnostic Scoring System to Distinguish Precocious Puberty from Premature Thelarche based on Clinical and Laboratory Findings

  https://brieflands.com/articles/ijp-64118

  The aim of the present study was to establish a new simple, fast, useful and cost-effective scoring system based on clinical and laboratory findings to distinguish PP from PT and its variants as an alternative or complementary approach to the GnRH test. […] We aimed to establish a newly scoring model as a complementary or alternative diagnostic approach to GnRH test that distinguishes PP from PT. […] Our scoring model is the first report that establishes differential diagnosis of precocious puberty. […] The proposed diagnostic scoring system based on clinical and laboratory findings offers a standard, cost-effective and simple approach to the differential diagnosis of PP, PT and its variants.

• #55 Development and Validation of Clinical Diagnostic Model for Girls with Central Precocious Puberty: Machine-learning Approaches | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261965

  A brief gonadotropin-releasing hormone analogues (GnRHa) stimulation test which solely focused on LH 30-minute post-stimulation was considered to identify girls with central precocious puberty (CPP). […] We aimed to develop a machine learning-based diagnostic model that processed baseline CPP-related variables and a brief GnRHa stimulation test for CPP diagnosis. […] Girls received a CPP diagnosis if they exhibited the following criteria: (a) onset of secondary sexual characteristics including breast development and/or pubic hair development at age 8 years and (b) peak LH level 5 IU/L combined with a ratio of peak LH to FSH value 0.6 after GnRHa stimulation test. […] The model was achieved according to the highest performance metric of F1-score (0.976) and a high AUC value (0.972). […] Our finding indicates the trend of CPP diagnosis using a machine learning-based model that helps make a better diagnosis than traditional methods.

• #56 Development and Validation of Clinical Diagnostic Model for Girls with Central Precocious Puberty: Machine-learning Approaches | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261965

  The current model yielded a higher AUC value ranging from 0.981 to 0.984 than those of the model proposed by Pan et al., especially in terms of sensitivity and specificity, which are crucial metrics indicating the number of correctly predicted CPP cases. […] Our diagnostic model conveyed the important clinic features, such as basal LH, BA-CA, and 30-min LH, that make it reliable and effective in diagnosing CPP in girls.

• #57 SciELO Brazil – Central precocious puberty: revisiting the diagnosis and therapeutic management Central precocious puberty: revisiting the diagnosis and therapeutic management

  https://www.scielo.br/j/aem/a/Tpzrbb9PdZR7FcnkJw7C69f/?lang=en

  Clinical and laboratory diagnosis and treatment of central precocious puberty (CPP) remain challenging due to lack of standardization. […] The diagnosis of CPP is based mainly on clinical and biochemical parameters, and a period of follow-up is desirable to define the progressive form of sexual precocity. […] Measurement of basal and stimulated LH levels remains challenging, considering that the levels are not always in the pubertal range at baseline, short-acting GnRH is not readily available in Brazil, and the cutoff values differ according to the laboratory assay. […] When CPP is suspected but basal LH values are at prepubertal range, a stimulation test with short-acting or long-acting monthly GnRH is a diagnostic option. […] The main objective of evaluating patients with precocious puberty is to identify benign conditions from others caused by diseases like tumors, which require immediate and objective management.

• #58 Evaluation of the diagnostic value of different serum biomarkers in girls with central precocious puberty | Egyptian Pediatric Association Gazette | Full Text

  https://epag.springeropen.com/articles/10.1186/s43054-024-00291-1

  Alarming trends show an increase in referrals of girls with suspected early puberty. […] GnRH stimulation test is the gold standard diagnostic test, which is expensive and challenging to interpret. […] Therefore, we sought to evaluate the diagnostic performance of basal serum Luteinizing Hormone and Anti-Mullerian hormone in girls with central precocious puberty, as an easier alternative to GnRH stimulation test. […] The diagnosis and management of PP constitute a major challenge. […] To distinguish between different categories of PP, the GnRH stimulation test (GnRHST), which evaluates peak luteinizing hormone (LH) after GnRH agonist stimulation, is still recognized as the gold standard test. […] Therefore, there is an unmet clinical need to search for simple affordable biomarkers such as serum LH and AMH that could overcome the disadvantages of GnRHST and evaluate their performance in diagnosing CPP in girls.

• #59 Precocious Puberty – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK544313/

  Bone age is an initial screening test. If the bone age is advanced (greater than two standard deviations) than the chronologic age, further testing should follow. Hormonal testing differentiates peripheral and central causes. A baseline prepubertal LH level of greater than 0.3 IU/L is suggestive of CPP. Levels under 0.3 are indicative of peripheral causes or benign variants. […] The decision to treat depends on the age of the child and the progression of puberty. If the child has rapidly progressing symptoms or if bone age is significantly advanced, consider treatment. The main goals of treatment are to preserve the adult height and to alleviate the associated psychosocial stress. […] Precocious puberty requires differentiation from the benign forms of puberty.

• #60 Definition, etiology, and evaluation of precocious puberty – UpToDate

  https://www.uptodate.com/contents/definition-etiology-and-evaluation-of-precocious-puberty

  Definition, etiology, and evaluation of precocious puberty […] Precocious puberty is the onset of pubertal development at an age that is 2 to 2.5 standard deviations (SD) earlier than population norms. The cause of precocious puberty may range from a variant of normal development (eg, isolated premature adrenarche or isolated premature thelarche) to pathologic conditions with significant risk of morbidity and even death (eg, malignant germ-cell tumor or astrocytoma). […] The clinician faced with a child who presents with early development of secondary sexual characteristics should consider the following questions: […] Is the child too young to have reached the pubertal milestone in question? – To answer this question, the clinician needs to know the normal ages for pubertal milestones and how to distinguish normal from abnormal development. […] What is causing the early development? – To answer this question, the clinician ascertains whether the development of secondary sexual characteristics is attributable to androgen and/or estrogen effects and whether the source of sex hormone is centrally mediated through the hypothalamic-pituitary-gonadal axis, from an autonomous peripheral origin, or has an exogenous basis. […] Is therapy indicated, and, if so, what therapy?

• #61 Precocious Puberty: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/924002-overview

  Because of the development of more sensitive third-generation assays for luteinizing hormone (LH), which can detect levels as low as 0.1 IU/L or lower, random LH is now considered a good screening test for CPP, with levels of 0.3 IU/L or above considered diagnostic. […] Measurement of serum testosterone is useful in boys with suspected precocious puberty. […] When used to determine bone age, radiography of the hand and wrist is a quick and helpful means of estimating the likelihood of precocious puberty and its speed of progression. […] If the history, physical examination, and laboratory data suggest that a child exhibits early and sustained evidence of pubertal maturation, the clinician must differentiate CPP from precocious pseudopuberty. […] Correct diagnosis of the etiology of sexual precocity is critical because the evaluation and treatment of patients with precocious pseudopuberty are quite different from those of patients with CPP.

• #62 What Primary Care Providers Need to Know About Precocious Puberty – Pediatrics Nationwide

  https://pediatricsnationwide.org/2024/09/27/what-primary-care-providers-need-to-know-about-precocious-puberty/

  PCPs are the first line of defense in recognizing and referring possible cases of precocious puberty to endocrinologists for formal diagnosis and treatment. […] When we initially suspect precocious puberty it’s often fairly evident from a physical exam, but we may also do baseline blood tests to measure sex hormones and gonadotropins and a hand X-ray to assess their skeletal maturation. […] If families choose to treat precocious puberty with suppression, the drugs are very effective. If we start early enough, we can postpone puberty until the child is at a normal age for puberty, easing that process for the family emotionally and helping the child reach their optimal post-pubertal height. […] Dr. Lahoti: There are definitely some health implications for children who start puberty early and continue to progress. They are then the only one in their age group going through those changes. Even at the right age for puberty, it’s difficult to deal with from an emotional and physical standpoint—let alone trying to deal with it when a child is not mature enough to understand what is going on yet.

• #63 A narrative review: treatment outcomes of central precocious puberty (CPP) – Ergun-Longmire – Pediatric Medicine

  https://pm.amegroups.org/article/view/6779/html

  The goals of treatment are to preserve the adult height potential and prevent/alleviate psychosocial sequelae and stress. […] Treatment with GnRHa is generally considered safe, well-tolerated, and effective. […] Final adult height is one of the most often measured standards to determine the efficacy of CPP treatment with GnRHa. […] One of the parental concerns about GnRHa treatment for CPP is whether their child’s reproductive function will be affected adversely. […] There have been concerns that PCOS may occur more often in those with CPP than in those with normal puberty. […] Few data are available on the reproductive outcomes of males treated for CPP and limited to a small number of studies. […] Early-onset of puberty has been observed more commonly in girls with increased BMI.

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