Precocious puberty

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Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Precocious puberty
• Timing and progression of pubertal changes, growth velocity, exposures, neurologic symptoms, and examination reviewed
• No headaches or vision changes or exposure to estrogen or testosterone creams or medicines
• Progressive pubertal changes concerning for precocious puberty
• Bone age ordered
• Morning LH, FSH, and estradiol ordered
• Referred to pediatric endocrinology
• Follow up after the results

Early puberty is most often not caused by a serious problem, but the evaluation looks for causes that need treatment and checks whether early bone maturation could affect adult height. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Title: precocious puberty, premature thelarche, premature adrenarche
Findings (breast, pubic hair, body odor, testes, growth spurt, vaginal bleeding)
Red flags present or absent (neurologic, rapid progression, growth acceleration, hormone exposure)
Assessment: progressive precocious puberty vs isolated thelarche vs isolated adrenarche
Bone age
Morning LH, FSH, estradiol or testosterone
Endocrinology referral vs if progressing
Follow-up after results; 3 or 6 months for isolated changes
Paragraph per branch

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.