Precocious puberty in children after traumatic brain injury

True precocious puberty frequently occurs secondary to central nervous system pathology and is a rare sequelae of severe head injury in early childhood. It is a clinical entity consisting of accelerated somatic development, thelarche and pubarche. We describe two female children, 3 and 5 years of age, who, following head trauma, displayed early pubertal changes including breast enlargement, pubic hair and vaginal secretions. Subsequent laboratory tests, which included hormone assays and luteinizing hormone response after injection of luteinizing hormone releasing hormone, established the diagnosis of precocious puberty of central origin. Long-term sequelae of this condition include accelerated skeletal growth and advanced bone age eventually resulting in short stature. The most effective form of treatment is long-acting luteinizing-hormone-releasing-hormone agonists, which result in temporary reversible chemical castration.