The first sign of centrally driven puberty in girls is breast bud development. This often accompanies acceleration in linear growth. This is considered abnormal when the onset is before the age of 8 years.
Assessment should include: history of growth acceleration with plotting of height on growth chart, ideally plotting of both parents’ height, and clinical examination for signs of pubertal development. Family history of pubertal timing can also be helpful.
If considering blood tests prior to referral then please include LH/FSH/oestradiol and TFTs.
Precocious Puberty in Girls
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Note that this email address contacts the team managing the website rather than the service itself; as such, please do not reach out with clinical queries or concerns.
Note that this email address contacts the team managing the website rather than the service itself; as such, please do not reach out with clinical queries or concerns.
Initial Management
Who to Refer
- The Tayside precocious puberty/adrenarche pathway gives more detailed guidance on differentiating precocious puberty from the normal variant adrenarche
- Please refer girls with onset of pubertal development before the age of 8 years to paediatric endocrinology via SCI gateway.
- Occasionally, puberty blocker treatment for older girls may be considered, for example in the context of learning difficulties. These girls warrant further discussions.
Who Not to Refer
Girls with pubertal onset after the age of 8 years with no other concerning features.
How to Refer
Sci Gateway Paediatric Endocrinology
Useful Resources
The Scottish paediatric endocrine group website contains useful SPEG parent information leaflets, including on GNRH testing and precocious puberty:
RCPCH Growth Charts
RCPCH Growth Charts