Chapter 31 PRECOCIOUS PUBERTY
Normal puberty begins in girls between 8 and 14 years of age with breast buds and skeletal growth, followed by the arrival of pubic hair, axillary hair, and menarche. The age at which pubertal milestones are attained varies. In addition, it is influenced by activity level and nutritional status. Girls with low body fat may have a significant delay in menarche (up to a year or more), whereas obese girls may have earlier onset of puberty.
• Simple premature thelarche involves only breast development (unilateral or bilateral) without pubic hair growth, without accelerated bone maturation, and with a normal height outcome. No treatment is required. The disorder is usually self-limited and can resolve spontaneously or persist to normal puberty.
• Simple premature adrenarche involves only pubic hair development (pubic and axillary) without the other manifestations of puberty. No treatment is required, although the possibility of late-onset congenital adrenal hyperplasia should be investigated with a measurement of the serum 17α-hydroxyprogesterone level. There is an increased incidence of simple premature adrenarche in patients with CNS abnormalities.
