Precocious puberty

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Precocious puberty



Precocious puberty


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Precocious puberty

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USMLE® Step 1 style questions USMLE

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A 6-year-old boy is referred to an endocrinologist by his pediatrician due to concerns about the child’s development. The patient’s parents report that he has had pubic, axillary and chest hair growth over the past six months. They note that the child also gained several inches in height over the same period. Currently, the patient is at the 89th percentile for height and 76th percentile for weight. Physical examination reveals coarse pubic, chest and axillary hair. The testes are markedly enlarged without evidence of extra-seminal masses. Which of the following findings is most likely to be found on further evaluation?  

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Pediatric patients

precocious puberty in p. 55, 338

Precocious puberty

adrenal steroids and p. 338

leuprolide p. 680

McCune-Albright syndrome p. 55, 714

pinealoma p. 546


precocious p. 55, 338


Puberty is the time in an individual’s life when they physically become sexually mature and able to have children. Precocious refers to puberty occurring at an earlier age than the average age among an individual’s peers. Generally, puberty is considered precocious if it begins before the age of 8 in females and the age of 9 in males.

The hypothalamic-pituitary-gonadal axis is a system of hormone signaling between the hypothalamus, pituitary gland, and gonads, either the testes or ovaries, to control sexual development and reproduction. Gonadotropin-releasing hormone is released by the hypothalamus into the hypophyseal portal system, which is a network of capillaries connecting the hypothalamus to the hypophysis, or the pituitary.  When gonadotropin-releasing hormone reaches the pituitary gland, it stimulates cells in the anterior pituitary, called gonadotrophs, to release gonadotropin hormones — luteinizing hormone and follicle-stimulating hormone — into the blood. These gonadotropin hormones then stimulate the gonads to produce specific steroids, sex hormones

Beginning at puberty, the Leydig cells of the testes respond to the luteinizing hormone by converting more cholesterol into testosterone. In addition, the Sertoli cells of the testes respond to follicle-stimulating hormone by producing more sperm


Precocious puberty, also known as early puberty, refers to the occurrence of secondary sexual characteristics in children before the age of 8 in girls and before the age of 9 in boys. In some children, early development is triggered by a disease such as a tumor or injury of the brain. Precocious puberty can also be a result of other pathologies such as pinealoma, McCune-Albright syndrome, and 21-hydroxylase deficiency. Treatment for precocious puberty usually involves hormone therapy or medications to suppress the early activation of the hypothalamic-pituitary-gonadal axis.


  1. "Robbins Basic Pathology" Elsevier (2017)
  2. "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
  3. "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
  4. "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
  5. "Central Precocious Puberty" Pediatric Drugs (2004)
  6. "<i>LIN28B</i>polymorphisms are associated with central precocious puberty and early puberty in girls" Korean Journal of Pediatrics (2012)

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