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.
Precocious puberty can be divided into central, also known as
gonadotropin-dependent
precocious puberty or true
precocious puberty, and peripheral, also recognized as
gonadotropin-independent
precocious puberty or
precocious pseudopuberty. Thus, the main aim of this narrative report is to describe the standard clinical management and
therapy of
precocious puberty according to the experience and expertise of pediatricians and pediatric endocrinologists at Policlinico Umberto I, Sapienza University of Rome, Italy. 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. Brain MRI should be performed as indicated by the 2009 Consensus Statement in all boys regardless of chronological age and in all girls with onset of pubertal signs before 6 years of age. The gold standard in the treatment of
central precocious puberty is represented by
GnRH analogs, whereas, as far as peripheral forms are concerned, the triggering cause must be identified and treated. At the moment there are no reliable data establishing the criteria for discontinuation of
GnRH analog
therapy. However, numerous pieces of evidence suggest that the
therapy should be suspended at the physiological age at which puberty occurs.