Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society.
In 1997 a study from the Pediatric Research in Office Settings network, based on pubertal staging of >17,000 girls between 3 and 12 years of age, indicated that breast and pubic hair development are occurring significantly earlier than suggested by our current guidelines, especially in African-American girls. In response to this article, the Lawson Wilkins Pediatric Endocrine Society undertook a comprehensive review of this topic. The primary conclusions of this review are: 1. The current recommendation that breast development before age 8 is precocious is based on outdated studies. Until 1997, no data were available on pubertal staging in US girls that could have documented a trend to earlier maturation. 2. The 1997 study indicates that stage 2 of breast and pubic hair development is being achieved ~1 year earlier in white girls and 2 years earlier in African-American girls than previous studies have shown. 3. Concerns that girls with moderately precocious puberty will be significantly short adults are overstated; most have adult height within the normal range. 4. Therapy with gonadotropin-releasing hormone agonists has not been proven to have a substantial effect on adult height in most girls whose puberty starts between 6 and 8 years of age. 5. New guidelines propose that girls with either breast development or pubic hair should be evaluated if this occurs before age 7 in white girls and before age 6 in African-American girls. No changes in the current guidelines for evaluating boys (signs of puberty at younger than 9 years) can be made at this time.normal puberty, breast development, pubic hair.
Kaplowitz
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Department of Pediatrics, the Medical College of Virginia of Virginia Commonwealth University, Richmond, Virginia, USA. pkaplowitz@hsc.vcu.edu
Oberfield
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D017668:Age of Onset; D001940:Breast / Q000254:growth & development; D002648:Child; D002675:Child, Preschool; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006130:Growth Disorders / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D017410:Practice Guidelines as Topic; D011627:Puberty / Q000502:physiology*; D011629:Puberty, Precocious / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D012016:Reference Values; D014481:United States / Q000453:epidemiology
D005300:Fertility Agents, Female; D007987:Gonadotropin-Releasing Hormone