{"id":25293,"date":"2025-09-10T12:51:40","date_gmt":"2025-09-10T11:51:40","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=25293"},"modified":"2025-09-23T10:39:53","modified_gmt":"2025-09-23T09:39:53","slug":"precocious-puberty-in-girls","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-endocrinology-diabetes\/puberty\/precocious-puberty-in-girls\/","title":{"rendered":"Precocious puberty in girls"},"content":{"rendered":"\n<p class=\"has-standard-black-color has-text-color has-link-color wp-elements-3d8f94cc406636878ed0e4e6106b5ed4\">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.<br><a><u>Initial assessment should include<\/u>:<\/a><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>history of growth acceleration with plotting of height on&nbsp;<a href=\"https:\/\/www.rcpch.ac.uk\/resources\/growth-charts\" target=\"_blank\" rel=\"noreferrer noopener\">growth chart<\/a>, ideally plotting of both parents\u2019 height<\/li>\n\n\n\n<li>clinical examination for signs of pubertal development<\/li>\n\n\n\n<li>family history of pubertal timing where available.<\/li>\n<\/ul>\n\n\n\n<p>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 <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-endocrinology-diabetes\/puberty\/adrenarche\/\" target=\"_blank\" rel=\"noreferrer noopener\">adrenarche<\/a>.<\/p>\n\n\n\n<p><strong>C.M. &amp; E.B. 23-09-25<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>If considering blood tests prior to referral then please include LH\/FSH\/oestradiol and TFTs.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Who to refer:<\/strong><strong><\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Girls with breast development and growth acceleration before the age of 8 years.<\/li>\n\n\n\n<li>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.<\/li>\n\n\n\n<li>If considering blood tests prior to referral then please include LH\/FSH\/oestradiol and TFTs.<\/li>\n\n\n\n<li>Girls who reach menarche before the age of 10 years.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer:<\/strong><strong><\/strong><\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Girls with pubertal onset <em>after<\/em> the age of 8 years with no other concerning features.<\/li>\n\n\n\n<li>Girls with <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatric-endocrinology-diabetes\/puberty\/adrenarche\/\" target=\"_blank\" rel=\"noreferrer noopener\">adrenarche<\/a> and no red flags.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer:<\/strong><strong><\/strong><\/h4>\n\n\n\n<p>Please refer via SCI Gateway to RHCYP &#8211; Endocrinology<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>The Scottish paediatric endocrine group website contains useful&nbsp;<a href=\"https:\/\/www.speg.scot.nhs.uk\/patients-and-families\/information-leaflets\/\" target=\"_blank\" rel=\"noreferrer noopener\">SPEG parent information leaflets,<\/a>&nbsp;including on GNRH testing and precocious puberty.<br><br><a href=\"https:\/\/www.rcpch.ac.uk\/resources\/growth-charts\" target=\"_blank\" rel=\"noreferrer noopener\">RCPCH Growth Charts<\/a><\/p>\n\n\n\n<p><\/p>\n<\/div><\/div>\n<\/div>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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: Signs of androgen exposure, such as pubic hair growth, greasy skin or body odour, in the absence of<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":25163,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1319],"class_list":["post-25293","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-precocious-puberty-in-girls"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/paediatric\/https-apps-nhslothian-scot-refhelp-paediatric-endocrinology-diabetes\/https-apps-nhslothian-scot-refhelp-precocious-puberty-in-girls\/\" rel=\"tag\">Precocious puberty in girls<\/a>","rttpg_excerpt":"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: Signs of androgen exposure, such as pubic hair growth, greasy skin or body odour, in the absence of","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25293","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=25293"}],"version-history":[{"count":4,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25293\/revisions"}],"predecessor-version":[{"id":25407,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25293\/revisions\/25407"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/25163"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=25293"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=25293"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}