PRECOCIOUS PUBERTY

A   6-year-old  girl    is  brought to  the office  by  her mother  who has noticed

breast  budding and pubic   hair    development on  her daughter.   She has also

experienced menstrual   bleeding.   Her childhood   history is  unremarkable

until   three   months  ago when    these   changes began.

The criteria for diagnosis of precocious puberty include development of female
secondary sexual characteristics and accelerated growth before age 8 in girls and
age 9 in boys. Precocious puberty is more common in girls than boys.

Normal Pubertal Landmarks. Complete puberty is characterized by the
occurrence of all pubertal changes.

Diagnosis Female    secondary   sexual  characteristics Accelerated growth  <8  years   of

age in  girls

Normal  pubertal

landmarks

9–10    years

10–11   years

The most    common initial  change  is  thelarche   (breast development at  age 9–

10).

This    is  followed    by  adrenarche  (pubic  and axillary    hair    at  age 10–11).

Maximal growth  rate    occurs  at  age 11  and 12.

Finally,    the last    change  is  menarche    (onset  of  menses  at  age 12–13).

Thelarche

Breast  development

Adrenarche

Pubic   and axillary    hair