Puberty is occurring earlier, probably related to an increase in BMI globally. This means that more children, particularly girls will be referred with early puberty. It is important to distinguish CPP from early normal puberty and this is done from two key parameters; the tempo or progression of puberty and evidence of LH secretion. Both are identifiable in girls with CPP. Clinical skills are needed to take a careful history and to examine the child and document stages of puberty. The phenomenon of adrenarche should be explained to parents=. If GnRH agonist therapy is indicated, this treatment should be initiated when definite precocious LH secretion is documented and the child has documented progression of pubertal signs before the age of 8 years. They key objective of GnRHa therapy is to suppress LH-dependent features, such as breast development and menstruation. Adult height gain is an added bonus and depends on the ability to reduce bone age advance. This is most effective in children <6 years of age. GnRHa therapy is safe and effective, but should continue for at least 2 years to fulfil its aims.
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