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      Precocious Puberty and Normal Variant Puberty: Definition, etiology, diagnosis and current management

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          This review describes several aspects of the management of precocious puberty (PP) and variants in girls and boys.

          PP is characterized by early pubertal changes, acceleration of growth velocity and rapid bone maturation that often result in reduced adult height. Onset of pubertal signs before the age of 8 years in girls and 9 years in boys should always be evaluated carefully. The main principles of therapy are to stop the progression of secondary sex characteristics and menses (in girls), to increase final adult height, to promote psychosocial well-being, and to treat the underlying cause if known.

          Conflict of interest:None declared.

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          Most cited references 32

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          Early puberty-menarche after precocious pubarche: relation to prenatal growth.

          Girls with precocious pubarche (PP; pubic hair at 0 SD), intermediate birth weight (0 to -2 SD), and lower birth weight (less than -2 SD). At the time of PP diagnosis, age, bone age, and BMI were similar across birth weight subgroups; circulating sex hormone-binding globulin and body height were reduced in PP girls with lower birth weight, and these remained so throughout pubertal development. Onset of puberty occurred earlier in PP girls with lower birth weight; so did menarche. Adult height differed by an average of 6.5 cm (approximately 1 SD) between the upper and lower birth weight subgroups; this difference was essentially achieved before puberty and even before PP. Menarche before age 12.0 years was twofold more prevalent in PP girls than in control subjects. Among PP girls, age at menarche was advanced by 8 to 10 months in lower versus higher birth weight girls. Menarche before age 12.0 years was threefold more prevalent among LBW-PP girls than in control subjects (approximately 75% vs approximately 25%). The link between prenatal growth restraint and early menarche is herewith extended to PP girls. In particular LBW-PP girls may become a target group for interventions directed toward normalization of pubertal onset and progression.
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            Early puberty: rapid progression and reduced final height in girls with low birth weight.

            To assess whether, in girls with early onset of puberty, low birth weight is a risk factor for rapid progression to menarche and for short adult stature. Longitudinal clinical assessment of 54 Catalan (Northern Spanish) girls followed from early onset of puberty (onset of breast development between 8.0 and 9.0 years of age) to final height. The timing of menarche and the final height were analyzed a posteriori according to birth weight, the cutoff level between normal and low birth weight subgroups being -1.5 standard deviation (SD; approximately 2.7 kg at term birth). Normal and low birth weight girls had similar target heights and characteristics at diagnosis of early puberty. However, menarche occurred on average 1.6 years earlier in low versus normal birth weight girls (11.3 +/-.3 years vs 12.9 +/-.2 years), and final height was >5 cm shorter in low birth weight girls (parental adjusted height SD: -.6 +/-.2 cm vs.3 +/-.2 cm). The timing of menarche and the level of final height in Catalan girls with early onset of puberty was found to depend on prenatal growth. Girls with normal birth weight tend to progress slowly through puberty with a normal timing of menarche and normal final height. In contrast, girls with low birth weight tend to progress relatively rapidly to an early menarche and to a reduced final height. If these findings are confirmed in other ethnic and/or larger groups, then a subgroup has been identified that will most likely benefit from any therapeutic intervention aiming at a delay of pubertal development and/or an increase of final height.
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              Management and outcome of central precocious puberty.


                Author and article information

                J Clin Res Pediatr Endocrinol
                Journal of Clinical Research in Pediatric Endocrinology
                Galenos Publishing
                June 2009
                8 December 2010
                : 1
                : 4
                : 164-174
                [1 ] Ankara University School of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
                +90-312-595 64 34+90-312-319 14 40 merihbtr@ 123456yahoo.com Ankara University School of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
                © Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.



                premature thelarche, premature pubarche, precocious puberty


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