Update on therapy for precocious puberty.

The onset of pubertal development before age 8 years in girls or 9 years in boys indicates precocious puberty. The numerous causes of precocious puberty can be classified as central or peripheral. CPP arises from premature activation of the hypothalamic-pituitary axis; therefore, it has hormonal and physical characteristics similar to normal puberty. PPP results from production of sex steroids independent of the hypothalamic-pituitary axis. All types of precocious puberty are characterized by rapid growth and skeletal advancement, leading to the paradox of the tall child becoming a short adult secondary to early epiphyseal fusion. The choice of therapy for precocious puberty is dependent on the underlying etiology with differing strategies employed for central and peripheral causes (Table 3). Long-acting GnRH-a provide effective, selective, and reversible therapy for CPP. GnRH-agonists are not effective in PPP; however, other agents such as testolactone, spironolactone, and ketoconazole can be used to manage the premature sexual maturation associated with these conditions.