Q. When would you consider pubertal development as precocious ?
A. There are variations in the onset of puberty in various parts of the word. It is generally considered precocious when any of the sex characteristics appear before the age of 8 year in girls and 9 years in boys. Menarche before the age of 10 years is also precocious.

Q. What are the various forms of precocious sexual development? How do you classify ?
A. Puberty can occur prematurely due to early activation of the hypothalamic-pituitary-gonadal(HPG) axis or due to underlying pathologic conditions involving the gonads, adrenals or ectopic sites. When the HPG axis is activated it is known as central or gonadotropin dependent true precocious puberty (CPP or TPP). Peripheral or pseudo precocious puberty (PPP) is gonadotropin independent. Here the pubertal development is partial or incomplete. CPP may be idiopathic or due to various CNS lesions. It is isosexual with complete physical and sexual maturation and establishment of reproductive gonadal function. Individual differences exist in its rate of progression. PPP can be iso or heterosexual, with only some of the sexual characteristics appearing early.

Occasionally CPP supervenes over PPP when the advanced state of skeletal maturation and the elevated sex steroid levels due to adrenal (e.g. CAH) or gonadal (ovarian cyst.) pathology provoke early maturation of the hypothalamic pituitary axis.

Besides these, there are conditions referred to as variants of pubertal development, which include premature thelarche (PT), and premature adrenarche (PA) or rarely premature menarche. These are more commonly encountered in girls and occur as isolated unsustained non-progressive phenomena. Linear growth and skeletal maturation are not usually advanced. This group of children require careful periodic observation as these isolated phenomena may occasionally herald the onset of CPP/TPP. Complete work up and intervention may become necessary in the event of further progression.