Did you know that the average age of puberty onset in girls has been declining for decades, and that early puberty can have lasting psychological, social, and physical consequences? Roshni Patel, a fourth-year medical student at the Medical College of Georgia, and Bianca Forte, WHNP, a Women's Health Nurse Practitioner with a specialty in Pediatric and Adolescent Gynecology at Wellstar MCG Health, to discuss the recognition, evaluation, and management of precocious puberty in girls. Specifically, they will:
Review the normal pubertal timeline and define precocious puberty in females
Distinguish between premature thelarche, premature adrenarche, and precocious puberty through history and physical exam findings
Discuss the initial diagnostic workup, including bone age studies, hormone levels, and the GnRH stimulation test
Differentiate central precocious puberty from peripheral precocious puberty and outline appropriate management for each
Address the mental health impact of early puberty and how to support young patients during the clinical encounter
Identify when to refer patients to Pediatric Endocrinology or Pediatric and Adolescent Gynecology
Special thanks to Dr. Rebecca Yang and Dr. Sarah Straka for peer reviewing this episode
Free CME Available: Link Coming Soon!
References:
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Berberoğlu M. Precocious puberty and normal variant puberty: definition, etiology, diagnosis and current management. J Clin Res Pediatr Endocrinol. 2009;1(4):164-174. doi:10.4274/jcrpe.v1i4.3
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Eckert-Lind C, Busch AS, Petersen JH, et al. Worldwide Secular Trends in Age at Pubertal Onset Assessed by Breast Development Among Girls: A Systematic Review and Meta-analysis. JAMA Pediatr. 2020;174(4):e195881. doi:10.1001/jamapediatrics.2019.5881
Hampl SE, Hassink SG, Skinner AC, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi:10.1542/peds.2022-060640
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Kota AS, Sharma L, Ejaz S. Precocious Puberty. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544313/
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