Case history
Case history #1
A 6-year-old girl presents with breast development. On examination, some pubic hair is also observed. The parents mention that the breast development started about 6 months ago but the pubic hair is more recent. She has been outgrowing clothes rather rapidly this year. Neurologic examination is normal.
Case history #2
A 4-year-old boy presents with rapid growth. Examination reveals a height on the 75th centile (previously on the 25th) and weight on the 50th centile. The midparental height is on the 25th centile. He has pubic hair stage 4, axillary hair stage 2, penile growth, scrotal changes, and a bone age of 9 years. However, his testes only measure 3 mL bilaterally (prepubertal).
Other presentations
Incomplete patterns of early pubertal development include premature thelarche (isolated breast development) and premature adrenarche (pubic and/or axillary hair, usually accompanied by axillary odor); the latter is due to early or exaggerated androgen secretion by a normal adrenal gland. Precocious puberty may be centrally mediated when the hypothalamo-pituitary-gonadal axis is prematurely activated, or may be due to an adrenal, testicular, or ovarian disorder. The pattern of endocrine change, in centrally mediated precocious puberty, is the same as in normal puberty (i.e., pubertal development is consonant). However, in adrenal, testicular, or ovarian disorders, pubertal development does not follow the pattern of normal puberty (i.e., it is disconsonant). Exposure to exogenous hormones such as the oral contraceptive pill or testosterone gels may be responsible for early pubertal development in rare cases. Prolonged sex steroid exposure has a direct maturational effect on the hypothalamus and can accelerate the onset of centrally mediated puberty.
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