🌸 Precocious Puberty · Central vs Peripheral · Breast development · Pubic hair · Testicular enlargement

Schwartz Clinical Handbook — Chapter 61 · CPP (idiopathic, hamartoma) · PPP (CAH, McCune‑Albright, ovarian cyst) · Premature thelarche · Premature adrenarche

Select age, sex, secondary sexual characteristics (breast, pubic hair, testicular volume), growth acceleration, neurologic signs, and lab clues (LH/FSH, estradiol, testosterone) → differentiate central precocious puberty (CPP, GnRH‑dependent) from peripheral (PPP, GnRH‑independent) and benign variants (premature thelarche, premature adrenarche).
⚠️ Red flags: rapid progression, neurologic symptoms (headache, vomiting, visual changes), café‑au‑lait spots (McCune‑Albright) → MRI brain, endocrine referral.

📋 Step 1 — Sexual characteristics & growth
📌 Diagnostic impressions
📖 Schwartz Ch 61

Select age, sex, Tanner stage, testicular volume (boys), breast development (girls), pubic hair, growth acceleration (>6 cm/year), neurologic signs, café‑au‑lait spots, and lab clues (LH, FSH, estradiol, testosterone) → differentiate central precocious puberty (CPP, elevated LH response) from peripheral precocious puberty (PPP, low LH, high sex steroids), premature thelarche, and premature adrenarche.

✔️ CPP: progressive, breast/testes symmetric, pubertal LH, advanced bone age.
✔️ PPP: isolated testosterone/estrogen, low LH, often virilization (boys) or isolated breast with ovarian cyst.
✔️ Premature thelarche: isolated breast, no growth acceleration, normal bone age.
✔️ Premature adrenarche: pubic hair alone, normal growth, normal bone age.
📘 Schwartz pearls (Chapter 61)
• Central precocious puberty: GnRH agonist (leuprolide) treatment.
• Premature thelarche: benign, no treatment needed.
• McCune‑Albright: café‑au‑lait spots, polyostotic fibrous dysplasia, PPP.
• Testotoxicosis: PPP in boys, familial, testosterone therapy.
• Bone age advanced (>2 SD) suggests progressive puberty.