Testosterone (best to obtain in the AM DHEA-S (the storage form) 17-OH serum progesterone LH FSH
Estrogen is a less reliable test
LH is the best single test for CPP lt 0.1 is prepubertal and gt 0.3 is pubertal
Definitive test is LH/FSH 30 minutes after GnRH infusion. FSH rise gtgt LH is prepubertal no increase suggests precocious pseudopuberty
Thyroid only if other concerns for hypothyroidism
11 Imaging Studies
Bone age determination
MRI of the brain after laboratory confirmation or suspicion of precocious puberty need to ask for pituitary cuts.
Girls less than 6 have much greater incidence of brain abnormalities associated with precocious puberty may opt not to image girls over 6yo
All boys should be imaged
Pelvic ultrasound for girls with precocious pseudopuberty looking for ovarian tumor or cyst
Gonadotropin-releasing hormone agonists (Lupron) suppress pituitary production of gonadotropins
Given daily as an IM injection
Annual cost is 10-15000
Nafarelin acetate (Synarel)
Second line therapy
Without treatment most girls with onset of precocious puberty after age 6 achieve a normal adult height and treatment generally provides a small height gain
Treatment can be started anytime before bone maturation is too advanced and allows growth without rapid bone maturation generally girls lt age 12 and boys lt age 13.
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