New guideline recommends tailored care for precocious puberty

Some subgroups of children with precocious puberty-such as older girls with slowly progressing puberty-may not need the same level of testing or treatment, according to a new Endocrine Society Clinical Practice Guideline released today.

Children who start puberty earlier than usual should be carefully evaluated so they receive the right care at the right time-without unnecessary tests or treatment. The Endocrine Society's guideline gives clinicians evidence-based suggestions to identify central precocious puberty, understand its causes and decide when and what treatment is appropriate."

Ana Claudia Latronico, M.D., Ph.D., guideline's writing group chair, University of São Paulo in São Paulo, Brazil

Central precocious puberty happens when a child's brain activates puberty-related hormones too early-before age 8 years in girls and before age 9 years in boys. This early hormone signaling triggers physical changes such as breast development in girls, testicular enlargement in boys, rapid growth, and, in some cases, early menstruation.

Early puberty can affect a child's adult height and is associated with long-term physical and emotional health risks, including psychosocial stress, heart disease, and some cancers later in life.

According to the guideline authors, puberty-pausing medication, which temporarily pauses the brain signals that start puberty, can be an effective treatment and has the potential to increase adult height as well as improve psychosocial and long-term health outcomes among children with early puberty.

"Some subgroups of children may not need the same level of testing or treatment. For example, older girls with slowly progressing precocious puberty often have normal adult height without intervention," said the guideline's writing group co-chair Stephanie Roberts, M.D., of Boston Children's Hospital in Boston, Mass. "We give clinicians suggestions that avoid unnecessary or invasive testing and treatment, such as sometimes initially using a period of observation by their health care provider, using simpler testing methods and individualizing treatment when indicated."

Suggestions from the guideline include: 

• Monitoring girls with early breast development with physical exams every 4-6 months before initiating diagnostic testing. 

• Observing girls under 7 years old for 4-6 months to distinguish slowly vs. rapidly progressing puberty, since slow progression often results in normal adult height without treatment. 

• Using simple first-line testing with a basal luteinizing hormone (LH) blood test rather than GnRH agonist stimulation testing. 

• Avoiding routine brain MRIs in older children (> 6 years in girls and > 7 years in boys) without neurological symptoms. 

• Not routinely doing genetic testing, especially for cases without a family history of early puberty. 

• Starting treatment with longer-acting puberty-delaying medications (rather than shorter-acting medications) whenever it is expected that longer-acting medications will be used for long-term therapy. 

• Not routinely using growth hormone therapy. 

• Not routinely doing frequent lab monitoring during treatment unless treatment failure is suspected. 

• Discontinuing therapy by early adolescence (about 10-11 years in girls, 11-12 years in boys). 

Other members of the Endocrine Society writing committee that developed this guideline include: Morgan Alonzo of Children's Hospital Colorado in Aurora, Colo.; Jesús Argente of Niño Jesús University Children's Hospital, the Autonomous University of Madrid, the Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (CIBEROBN), Carlos III Health Institute, IMDEA Food Institute, and CEIUAM+CSI in Madrid, Spain; Ana Pinheiro Machado Canton of the University of São Paulo; Jean-Claude Carel of Paris Cité University in Paris, France; Fernando Cassorla of the University of Chile in Santiago, Chile; Evangelia Charmandari of Athens Medical School in Athens, Greece; Erica Eugster of Indiana University School of Medicine in Indianapolis, Ind.; Anna Grandone of the University of Campania, Luigi Vanvitelli, Vico L. De Crecchio in Naples, Italy; Louise C. Greenspan of San Francisco Medical Center in San Francisco, Calif.; Elizabeth Hawse of Commonwealth Pediatrics in Lexington, K.Y.; Anders Juul of the University of Copenhagen in Copenhagen, Denmark; Paul Kaplowitz of Children's National Hospital in Washington, D.C.; M. Hassan Murad of Mayo Clinic in Rochester, Minn.; Maria Street of the University Hospital of Parma in Parma, Italy; Vayana Walker of the Community Health Network in Indianapolis, Ind.; and Christopher McCartney of West Virginia University in Morgantown, W.V.

"Central Precocious Puberty: An Endocrine Society Clinical Practice Guideline," was published online and is being presented Saturday at ENDO 2026, the Society's annual meeting.

The guideline will appear in the September print issue of The Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of the Endocrine Society.