Journey Overview

Puberty is a multi-year biological process where the body becomes physically and sexually mature. In humans, this typically occurs between the ages of 8 and 13 for females and between the ages of 9 and 14 for males. Puberty is guided by hormones released by the hypothalamic-pituitary-gonadal (HPG) axis, the body’s main connection between the brain and reproductive organs. These hormones trigger growth, development, and maturation.

Central precocious puberty (CPP) is a rare condition where the HPG axis activates puberty at an earlier age. Symptoms include early changes in body hair, acne, rapid growth spurts, breast development, and early maturation of reproductive organs. This often causes emotional and social distress. It can also lead to reduced height in adulthood as bone growth both begins and ends at an earlier age.

In most cases, the underlying cause is unknown. However, some cases of CPP result from an underlying issue in the brain or central nervous system, such as a tumor.

If you are caring for a child with central precocious puberty, this guide can help you understand the healthcare providers you’ll work with, the questions to ask at appointments, and how CPP can be managed.

Your Multidisciplinary Team

A child living with CPP will work with a team of healthcare providers with different specialties. This team can include:

  • Pediatric endocrinologist

    Care for CPP is led by a pediatric endocrinologist. This is a medical doctor who specializes in hormone-related conditions in children and adolescents. This provider will confirm the diagnosis, order and interpret tests, prescribe and adjust treatment, and monitor a child's growth and development.

  • Pediatrician/primary care provider

    A pediatrician or primary care provider is often the first healthcare provider to notice the signs of CPP and to refer a child to a specialist. They continue to play an important role by providing routine checkups, vaccinations, and care for everyday illnesses, and also by helping coordinate care among your team.

  • Counselors

    Experiencing puberty at an earlier age than your peers can be socially and psychologically challenging, and is associated with a higher risk of stigma, depression, anxiety, substance use, and engaging in high-risk behaviors. Social workers and mental health professionals are often valuable to children with CPP and family members.

  • Additional team members

    Nurses play an integral role in care, including patient education, monitoring treatment adherence and side effects, and communication with the healthcare team. Depending on the underlying cause of CPP, a treatment team may include additional specialists, surgeons, and geneticists.

Treatment for CPP

  • The main goals of treatment are to support growth to adult height and ease the psychological and social challenges of CPP.
  • Treatment is individualized, and depends on underlying causes/contributing factors, the child’s age, and how fast puberty is progressing.
  • In cases where progression is slow and mild, treatment may begin with monitoring, and monitoring may be the primary treatment.
  • Medications called gonadotropin-releasing hormone (GnRH) agonists are a standard therapy for CPP. These medications lower hormone levels, delaying puberty and allowing bone growth/maturation to continue. GnRH agonists can be safely stopped to resume puberty.
  • Mental health and social support are important elements of treatment.

Treatment begins with an accurate diagnosis. This includes a thorough investigation of potential underlying causes and ruling out other more benign forms of early puberty. Diagnosis will include blood tests to measure hormone levels, imaging tests to check for tumors, and X-rays of the hand/wrist to check bone age. A healthcare team will be your best source of information.

The Conversation: Questions for your healthcare team

Good communication with a healthcare team is an essential part of treatment. These questions can help you get started.

Questions about the diagnosis:

  • What are the most important things I need to know about my child’s diagnosis?
    • Is the cause unknown? Is there an underlying cause?
    • How quickly is puberty progressing? How is it affecting bone development?
    • What are the potential problems or complications?
  • Can I have copies of lab reports, imaging studies, and other documents related to the diagnosis?
    • It helps to keep your own medical files, especially if you will be working with multiple providers and specialists.
    • Examples include results of blood tests, MRIs, ultrasounds, and X-rays.
    • Are there questions about the diagnosis that we still need to answer? Are there any additional tests we need at this moment?

    Questions about treatment:

    • What is the current treatment recommendation?
    • How often should we have follow-up appointments?
      • What can we expect at checkups? What tests are used to monitor development and symptoms?
      • Who can I contact if I have a question or concern between appointments?
    • If treating with a GnRH agonist:
      • How does this medication work?
      • What are the goals of using this treatment?
      • How is this medication administered and how often? What are the options for administration and dosing?
      • What side effects should I watch for?
      • How will we decide when to stop this medication and what will happen after this medication is stopped?

    Questions about emotional and social support:

    • How can I talk to my child about this diagnosis in a way they'll understand?
    • Do you have patient education materials I can take with me?
    • What psychological or social support are available for my child?
    • Who can I talk to about practical concerns, such as the cost of treatment, insurance, or other resources to support my family?

    Your child's appointments are an opportunity to learn more about their diagnosis. If you have a question, ask. If something isn't clear, ask for an explanation.

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