PAG

Question 1

Usual sequence of puberty?

Answer 1

Thelarche
Adrenarche (axillary and pubic hair)
Maximal growth velocity
Menarche

Question 2

What is main concern re precocious puberty?

Answer 2

Stunted growth due to early skeletal maturation

Question 3

2 categories of precocious puberty?

Answer 3

GnRH dependent (central) ‘true’ occurring at wrong time

GnRH independent (peripheral-not ‘true’ puberty but signs of)

Only true puberty can result in regular menses/pregnancy risk

Question 4

Precocious puberty cause?

Answer 4

Central
80% idiopathic
20% CNS

Peripheral
Ovarian tumour eg granulosa cell m common
McCune Albright (rare café au lait spots)

Question 5

Does hypothyroid cause precocious puberty?

Answer 5

Rarely
More common delayed puberty
However if there is increased production of TSH in response to primary thyroid failure (hashimoto) may cause increase in fsh/lh too

Question 6

Point of work up if sign precocious puberty?

Answer 6

Rule out a life threatening neoplasm of ovary/adrenal/CNS

History and exam
Consider imaging of bones/CNS pelvis
LH/TFT/e2/prolactin/etc
GnRH agonist will produce detectable LH in ‘true’ hpo puberty

Question 7

Treatment of true hpo puberty?

Answer 7

GnRH agonists monthly/tri monthly eg leuprolide

Aim preserve height give asap will also resolve symptoms
Monitor e2 to ensure dose suppressed to pre pubertal
Stop around age 11