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Advances in Pediatrics

Update on Precocious Puberty: Girls are Showing Signs of Puberty Earlier, but Most Do Not Require Treatment

      Precocious puberty is one of the most common endocrine disorders seen by primary care physicians and continues to be a major source of concern for both parents and providers. Since the author’s previous review on this subject in Advances In Pediatrics in 2004 [
      • Kaplowitz P.
      Precocious puberty: update on secular trends, definitions, diagnosis, and treatment.
      ], there have been several reports that have added to the knowledge base and confirmed that signs of puberty in girls are appearing earlier than in the past in the United States as well as in other countries. In this article, the author reviews what pediatricians should know about the physical findings seen during normal puberty and their hormonal basis. The evidence that signs of puberty are appearing earlier than 30 to 40 years ago, at least in girls, and the major theories about why this might be occurring are also discussed. However, the key point to be made is that pediatricians should be able to recognize the benign causes of early breast and pubic hair development, which are, at least in the United States, far more common than the cases that might benefit from treatment. The current state of knowledge concerning the diagnosis and treatment of central (true) precocious puberty (CPP) and the red flags that might point toward one of the rare causes of gonadotropin-independent precocious puberty (GIPP) are then reviewed.
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