Child with Suspected Sexual Precocity

Referral Guidelines are peer reviewed guidelines developed to assist referring providers in their approach to a patient presenting with common signs or symptoms suggestive of an endocrine condition, and when to refer to Pediatric Endocrinology.

Suggestive history and physical findings:

Females before 8 yrs of age:

Estrogenic: Breast development, vaginal discharge/bleeding

Androgenic: Pubic hair, axillary hair body odor, acne

Males before 9 yrs of age:

Testicular enlargement, pubic hair, axillary hair, body odor, acne

For both sexes:

Growth acceleration, exposure to exogenous hormones, history of brain injury or radiation, family history of early puberty, midline defects, severe hypothyroidism, café au lait macules, FH/history of neurofibromatosis

Refer to Differential Diagnosis section

Labs and/or radiology studies can include:

When to refer:

Items useful for consultation:

Patient Education Materials:

Differential diagnosis of sexual precocity Gonadotropin-dependent sexual precocity:

Idiopathic (80% of cases in females, 10% of cases in males)
CNS lesion
- Hypothalamic Hamartoma
- Other CNS tumors or lesions
Genetic abnormality
- Gain-of-function mutation of the G-protein-coupled kisspeptin-1 receptor (GPR54)
Sex-steroid exposure causing bone age advancement

Gonadotropin-independent sexual precocity

Normal variants
- Premature thelarche
- Premature adrenarche
Neuroendocrine
- LH/hCG excess
- Hypothyroidism
Adrenal
- Congenital adrenal hyperplasia
- Adrenal tumor
Gonadal
- McCune-Albright Syndrome
- Leydig cell tumor
- Ovarian tumor

Familial male-limited precocious puberty (testotoxicosis)

Additional Information:

Treatment:

Suggested References and Additional Reading:

Authors/date revised:

Downloadable PDF File

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