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Central precocious puberty: a review of diagnosis, treatment, and outcomes
Erika L Zevin1, Erica A Eugster1
1Division of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA.
Insights
Central precocious puberty (CPP) is early activation of the hypothalamic-pituitary-gonadal (HPG) axis. Treatment with gonadotropin-releasing hormone analogues aims to improve adult height and normalize development.
Area of Science:
- Pediatric Endocrinology
- Reproductive Medicine
- Genetics
Background:
- Central precocious puberty (CPP) involves premature activation of the hypothalamic-pituitary-gonadal (HPG) axis.
- Manifestations include early breast development in girls and testicular enlargement in boys.
- Causes range from intracranial pathology and steroid exposure to idiopathic and monogenic factors.
Purpose of the Study:
- To review the pathophysiology, risk factors, diagnosis, and management of CPP.
- To provide an overview of current understanding and treatment strategies for CPP.
- To highlight areas for future research, particularly psychological effects.
Main Methods:
- Comprehensive literature review of CPP.
- Summary of diagnostic criteria including clinical, biochemical, radiological, and genetic testing.
- Overview of treatment modalities, focusing on gonadotropin-releasing hormone analogues.
Main Results:
- CPP diagnosis requires multidisciplinary assessment.
- Gonadotropin-releasing hormone analogue therapy is the standard treatment.
- Treatment aims to optimize adult height and psychosocial development.
Conclusions:
- Effective management of CPP involves timely diagnosis and appropriate treatment.
- Long-term outcomes with current therapies are generally positive.
- Further research into the psychological impact of CPP is warranted.
Abstract:
Central precocious puberty (CPP) refers to early activation of the hypothalamic-pituitary-gonadal (HPG) axis and is manifested by breast development in girls or testicular enlargement in boys before the normal physiological age ranges. CPP can be precipitated by intracranial pathology, exposure to high levels of sex steroids, or environmental risk factors, but most cases are idiopathic. Monogenic causes have also been identified. In this Review, we summarise pathophysiology, risk factors, diagnosis, and management of CPP. Concern for CPP should prompt referral to paediatric endocrinology where diagnosis is confirmed by clinical, biochemical, radiological, and genetic testing. CPP is treated with a gonadotropin-releasing hormone analogue, the primary aims of which are to increase adult height and postpone development of secondary sexual characteristics to an age that is more commensurate with peers. Although long-term outcomes of treatment with gonadotropin-releasing hormone analogues are reassuring, additional research on the psychological effect of CPP is needed.
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