A Review on Update on Diagnosis and Therapeutic Management of Precocious Puberty’’ - A long with A Case Report

Abstract

Precocious Puberty (PP) is the attainment of secondary sex characters before the age of 8 in girls and 9 yrs in boys. It can be divided into Central PP(CPP)/True PP or Gonadotropin dependent PP and Gonadotropon independent PP(GIPP) or Pseudo PP. CPP is characterized by the premature activation of the hypothalamo-Pituitary-Gonadal Axis. Onset of secondary sex characteristics before age 8, which further progresses with increased growth velocity and bone age acceleration which ultimately ends in impaired adult height. Mutation studies have shown occasional mutations in KISS1. KISS1R, Makorin ring finger protein 3(MKRN3) genes as some of the genetic modifications. Treatment with Gonadotropin releasing hormone agonists remain the treatment of choice which helps in ultimate attainment of normal height till actual age of puberty. With further introduction of a yearly GnRH subcutaneous implant histerelin administration has become more convenient than the tedious monthly GnRH a in the form of leuprolide depot or decapeptyl depot. This review sums up the various causes of CPP and GIPP with an update of its management, differential diagnosis and a case report to highlight an example.