Precocious Puberty and Benign Variants in Female Children: Etiology, Diagnostic Challenges, and Clinical Management

Precocious puberty, defined as the onset of secondary sexual characteristics before age 8 in girls, presents a diagnostic challenge in distinguishing between normal variants and pathological conditions requiring intervention. Central precocious puberty (CPP) results from early activation of the hypo...

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Main Authors: Roberto Paparella, Arianna Bei, Lorenzo Brilli, Vittorio Maglione, Francesca Tarani, Marcello Niceta, Ida Pucarelli, Luigi Tarani
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Endocrines
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Online Access:https://www.mdpi.com/2673-396X/6/2/29
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author Roberto Paparella
Arianna Bei
Lorenzo Brilli
Vittorio Maglione
Francesca Tarani
Marcello Niceta
Ida Pucarelli
Luigi Tarani
author_facet Roberto Paparella
Arianna Bei
Lorenzo Brilli
Vittorio Maglione
Francesca Tarani
Marcello Niceta
Ida Pucarelli
Luigi Tarani
author_sort Roberto Paparella
collection DOAJ
description Precocious puberty, defined as the onset of secondary sexual characteristics before age 8 in girls, presents a diagnostic challenge in distinguishing between normal variants and pathological conditions requiring intervention. Central precocious puberty (CPP) results from early activation of the hypothalamic–pituitary–gonadal axis, whereas peripheral precocious puberty (PPP) arises from excess sex steroid production independent of gonadotropins. Benign variants, including premature thelarche and premature adrenarche, require careful differentiation to prevent unnecessary treatment. This review explores the physiological mechanisms governing puberty, the epidemiological trends influencing its early onset, and the genetic and environmental factors contributing to its variability in female children. A structured diagnostic approach incorporating clinical evaluation, hormone assessments, imaging studies, and genetic insights is discussed. Management strategies vary depending on the etiology, with gonadotropin-releasing hormone analogs recommended for CPP and targeted therapies for PPP. In contrast, benign variants often necessitate observation and periodic follow-up. Given the increasing prevalence of early puberty, further research is essential to refine diagnostic thresholds and optimize treatment protocols. Early and accurate identification of precocious puberty ensures appropriate intervention, mitigating potential risks associated with early maturation, including compromised adult height and psychosocial challenges.
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spelling doaj-art-da226efbc14b430a8c8d97d119ac3d162025-08-20T03:26:56ZengMDPI AGEndocrines2673-396X2025-06-01622910.3390/endocrines6020029Precocious Puberty and Benign Variants in Female Children: Etiology, Diagnostic Challenges, and Clinical ManagementRoberto Paparella0Arianna Bei1Lorenzo Brilli2Vittorio Maglione3Francesca Tarani4Marcello Niceta5Ida Pucarelli6Luigi Tarani7Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, ItalyDepartment of Maternal Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, ItalyPrecocious puberty, defined as the onset of secondary sexual characteristics before age 8 in girls, presents a diagnostic challenge in distinguishing between normal variants and pathological conditions requiring intervention. Central precocious puberty (CPP) results from early activation of the hypothalamic–pituitary–gonadal axis, whereas peripheral precocious puberty (PPP) arises from excess sex steroid production independent of gonadotropins. Benign variants, including premature thelarche and premature adrenarche, require careful differentiation to prevent unnecessary treatment. This review explores the physiological mechanisms governing puberty, the epidemiological trends influencing its early onset, and the genetic and environmental factors contributing to its variability in female children. A structured diagnostic approach incorporating clinical evaluation, hormone assessments, imaging studies, and genetic insights is discussed. Management strategies vary depending on the etiology, with gonadotropin-releasing hormone analogs recommended for CPP and targeted therapies for PPP. In contrast, benign variants often necessitate observation and periodic follow-up. Given the increasing prevalence of early puberty, further research is essential to refine diagnostic thresholds and optimize treatment protocols. Early and accurate identification of precocious puberty ensures appropriate intervention, mitigating potential risks associated with early maturation, including compromised adult height and psychosocial challenges.https://www.mdpi.com/2673-396X/6/2/29precocious pubertypremature thelarchepremature adrenarchechildrenfemale
spellingShingle Roberto Paparella
Arianna Bei
Lorenzo Brilli
Vittorio Maglione
Francesca Tarani
Marcello Niceta
Ida Pucarelli
Luigi Tarani
Precocious Puberty and Benign Variants in Female Children: Etiology, Diagnostic Challenges, and Clinical Management
Endocrines
precocious puberty
premature thelarche
premature adrenarche
children
female
title Precocious Puberty and Benign Variants in Female Children: Etiology, Diagnostic Challenges, and Clinical Management
title_full Precocious Puberty and Benign Variants in Female Children: Etiology, Diagnostic Challenges, and Clinical Management
title_fullStr Precocious Puberty and Benign Variants in Female Children: Etiology, Diagnostic Challenges, and Clinical Management
title_full_unstemmed Precocious Puberty and Benign Variants in Female Children: Etiology, Diagnostic Challenges, and Clinical Management
title_short Precocious Puberty and Benign Variants in Female Children: Etiology, Diagnostic Challenges, and Clinical Management
title_sort precocious puberty and benign variants in female children etiology diagnostic challenges and clinical management
topic precocious puberty
premature thelarche
premature adrenarche
children
female
url https://www.mdpi.com/2673-396X/6/2/29
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