Central Precocious Puberty in Boys and Girls: Similarities and Differences

Abstract

Central precocious puberty (CPP) is due to the premature activation of the hypothalamic–pituitary–gonadal axis, which is responsible for the appearance of secondary sexual characteristics. It occurs before the age of 8 and 9 in girls and boys, respectively. CPP shows higher incidence in females than in males. Causes of CPP are similar in both sexes, but the idiopathic form is more frequent in girls, while organic forms are more frequent in males. Recent studies demonstrated a role of some genetic variants in the pathogenesis of CPP. The diagnostic evaluation based on accurate physical examination, assessment of the pituitary–gonadal axis, pelvic sonography in girls, and determination of bone age. Magnetic resonance of the central nervous system should be done in all boys and selected girls. Since the 1980s, pharmacologic treatment involves the use of gonadotropin-releasing hormone (GnRH) analogs. These drugs are characterized by few side effects and long-term safety. Many data are available on the outcome of GnRH analog treated female patients, while poor data are reported in boys. Adult height is improved in both sexes.

The Role of Genetics in Central Precocious Puberty: Confirmed and Potential Neuroendocrine Genetic and Epigenetic Contributors and Their Interactions with Endocrine Disrupting Chemicals (EDCs)

“…In order to confirm clinical findings, as well as to differentiate central from peripheral causes of precocious puberty, biochemical evaluation is usually obtained. Although a random basal LH level of >0.3 IU/L is generally considered diagnostic for CPP [29], Mucaria et al summarized reports of other suggested LH cut off levels for the diagnosis of CPP [30].…”

“…In children with lower levels of LH but with physical manifestations concerning for progressive pubertal development, GnRH stimulation testing with leuprolide allows evaluation of LH and sex steroid response and may aid in distinguishing between central and peripheral precocious puberty [30,31]. Leuprolide stimulation is considered the gold standard in evaluating CPP; however, there are several cut-offs for leuprolide-stimulated LH levels that have been proposed, ranging from 5-8 IU/L, to indicate centrally mediated pubertal development [30,32].…”