Endocrine Society guideline addresses different subgroups of central precocious puberty
Some subgroups of children with precocious puberty – such as older girls with slowly progressing puberty – may not need the same level of testing or treatment, according to a new Endocrine Society Clinical Practice Guideline.
“Children who start puberty earlier than usual should be carefully evaluated so they receive the right care at the right time – without unnecessary tests or treatment,” said the guideline’s writing group chair, Ana Claudia Latronico, MD, PhD, of the University of São Paulo. “The Endocrine Society’s guideline gives clinicians evidence-based suggestions to identify central precocious puberty, understand its causes and decide when and what treatment is appropriate.”
Central precocious puberty happens when a child’s brain activates puberty-related hormones too early – before age 8 years in girls and before age 9 years in boys. This early hormone signalling triggers physical changes such as breast development in girls, testicular enlargement in boys, rapid growth, and, in some cases, early menstruation.
Early puberty can affect a child’s adult height and is associated with long-term physical and emotional health risks, including psychosocial stress, heart disease, and some cancers later in life.
According to the guideline authors, puberty-pausing medication, which temporarily pauses the brain signals that start puberty, can be an effective treatment and has the potential to increase adult height as well as improve psychosocial and long-term health outcomes among children with early puberty.
“Some subgroups of children may not need the same level of testing or treatment. For example, older girls with slowly progressing precocious puberty often have normal adult height without intervention,” said the guideline’s writing group co-chair Stephanie Roberts, MD, of Boston Children’s Hospital in Boston, Mass. “We give clinicians suggestions that avoid unnecessary or invasive testing and treatment, such as sometimes initially using a period of observation by their health care provider, using simpler testing methods and individualising treatment when indicated.”
Suggestions from the guideline include:
- Monitoring girls with early breast development with physical exams every 4-6 months before initiating diagnostic testing
- Observing girls under 7 years old for 4-6 months to distinguish slowly vs. rapidly progressing puberty, since slow progression often results in normal adult height without treatment.
- Using simple first-line testing with a basal luteinising hormone (LH) blood test rather than GnRH agonist stimulation testing.
- Avoiding routine brain MRIs in older children (> 6 years in girls and > 7 years in boys) without neurological symptoms.
- Not routinely doing genetic testing, especially for cases without a family history of early puberty.
- Starting treatment with longer-acting puberty-delaying medications (rather than shorter-acting medications) whenever it is expected that longer-acting medications will be used for long-term therapy.
- Not routinely using growth hormone therapy.
- Not routinely doing frequent lab monitoring during treatment unless treatment failure is suspected.
- Discontinuing therapy by early adolescence (about 10-11 years in girls, 11-12 years in boys).
The new guideline is available online.
Source: Endocrine Society
