The first sign of centrally driven puberty in girls is breast bud development. This often accompanies acceleration in linear growth. This is considered abnormal when the onset is before the age of 8 years.
Initial assessment should include:
- history of growth acceleration with plotting of height on growth chart, ideally plotting of both parents’ height
- clinical examination for signs of pubertal development
- family history of pubertal timing where available.
Signs of androgen exposure, such as pubic hair growth, greasy skin or body odour, in the absence of breast development, is more likely to represent adrenarche.
If considering blood tests prior to referral then please include LH/FSH/oestradiol and TFTs.
Who to refer:
- Girls with breast development and growth acceleration before the age of 8 years.
- Occasionally, puberty blocker treatment for older girls may be considered, for example in the context of significant learning difficulties/developmental delay. These girls warrant further discussions.
- If considering blood tests prior to referral then please include LH/FSH/oestradiol and TFTs.
- Girls who reach menarche before the age of 10 years.
Who not to refer:
- Girls with pubertal onset after the age of 8 years with no other concerning features.
- Girls with adrenarche and no red flags.
How to refer:
Please refer via SCI Gateway to RHCYP – Endocrinology
The Scottish paediatric endocrine group website contains useful SPEG parent information leaflets, including on GNRH testing and precocious puberty.
RCPCH Growth Charts
