Central precocious puberty (CPP) denotes a specific disease entity defined as premature development of secondary sexual characteristics in a girl (< 8 yrs) or boy (< 9 yrs) with activation of the hypothalamopituitary-gonadal (HPG) hormone axis. Such a GnRH-dependent precicious puberty are diagnosed as a combination of clinical characteristics including growth acceleration and pubertal signs, as well as advanced boneage and biochemical signs of CPP. The latter may include measurement of reproductive hormones and a pubertal response to a GnRH test. In girls with CPP a brain MRI should rule out CNS pathologies. Controversies regarding diagnostic aspects ash well as the appropriate age cut-off for brain MRI will be discussed.
Puberty marks the transition from the childhood phase to the attainment of full adult reproductive capacity. Timing of puberty shows wide interindividual variation, of which 60% can be explained by genetic factors as evidenced from twin- and mother-daughter studies. The remaining 40% of variation is explained by lifestyle and envonmental factors.
Age at pubertal onset in girls is classically observed when breast gland tissue starts to develop. A worldwide decline in age at breast development (helarche) has been demonstrated, and this trend appears to be ongoing. This worrying trend in the general population has occurred over just a few decades and must be explained by environmental (non-genetic) factors. It is paralleled by increasing number of girls referred to be evaluated for very early signs of puberty (precocious puberty). Thus, nation-wide registerbased studies from Denmark and South-Korea report marked increases in girls registered with a diagnosis of central precocious puberty.
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