Investigate girls with:
(1) pubic hair or breast development before 6 years of age
(2) any sign of puberty before 8 years of age with an acceleration of linear growth or skeletal maturation
(3) contrasexual precocious puberty (development appropriate for boys)
Investigate boys with:
(1) any sign of puberty before 7 years of age
(2) any sign of puberty before 9 years of age with an acceleration of linear growth or skeletal maturation
(3) contrasexual precocious puberty (development appropriate for girls)
(4) signs of precocious puberty without testicular enlargement
where:
• Contrasexual precocious puberty for boys would be gynecomastia.
• Contrasexual precocious puberty for girls may include excessive facial hair and hirsutism and/or clitoral enlargement.
Evaluation a girl with early breast development only (precocious thelarche) and no evidence of growth acceleration or skeletal maturation:
(1) search for exposure to exogenous estrogen
(2) serum levels of LH and FSH
(3) serum levels of estradiol
(4) bone age
Evaluation a boy or girl with early pubic hair development (precocious pubarche) and no evidence of growth acceleration or skeletal maturation:
(1) search for exogenous androgens
(2) serum levels of testosterone, dehydroepiandrostane and possibly androstenedione
(3) bone age
Evaluation a boy or girl with evidence of growth acceleration or skeletal maturation:
(1) history of exposure to exogenous sex steroid
(2) serum levels of gonadotropin hormones
(2a) If gonadotropins are pubertal, then perform an MRI of the hypothalamus.
(2b) If gonadotropins are low, LH-releasing hormone (LHRH) may be given and gonadotropins measured 45 minutes later. If the response to the test is pubertal, then an LHRH analogue should be given. This will preserve adult height if it is given before skeletal maturation has advanced significantly.
(3) serum levels of sex-steroid concentrations
Evaluation of contrasexual precocity (from Grumbach and Styne):
(1) evaluation of adrenal gland
(2) evaluation of ovaries or testis
(3) serum levels of sex-steroid concentrations
