Treatment of Central Precocious Puberty with a Focus on Girls

Central precocious puberty (CPP) refers to early maturation of the hypothalamic-pituitary-gonadal axis (HPG) axis with subsequent secondary sexual development.1 The age of thelarche has declined in the past few decades but not the age of menarche.2 This is important when assessing girls who present with breast development between 6 and 8 years because not all of them will need treatment.3 The decision for treatment depends on age, bone age (BA), rate of pubertal progression, height velocity, psychosocial factors, and predicted adult height (PAH), with the caveat that height predictions are not precise and BA interpretation is variable.4 A subset of children have a slowly progressive form of CPP and do not benefit from intervention in terms of final adult height.5 The primary goals of treatment in CPP are to align pubertal progression with peers, prevent menarche in very young girls, and preserve adult height. Gonadotropinreleasing hormone analog (GnRHa) treatment is very efficacious toward these goals.6 However, there is a demonstrable lack of randomized prospective studies in CPP, and the effect of GnRHas on adult height is multifactorial (chronologic age, pubertal stage, skeletal maturation, and tempo of puberty). Girls who start GnRHas before the age of