Precocious Puberty

Precocious puberty (early puberty) may be defined as the appearance of secondary sexual maturation at an early age. The age of onset of puberty before age 8 years in girls and

• Evaluation should begin if signs of puberty develop in girls younger than 8 years or boys younger than 9 years.

Tanner stage Breasts* Standard Pubic hair* Standard Growth Other

1 Prepubertal, elevation of papilla only


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Prepubertal, — Basal; about Adrenarche villus hair 5.0 to 6.0 cm Ovarian growth only (2.0 to 2.4 in)

per year

Breast bud appears under enlarged areola (11.2 years)

Sparse growth of slightly pigmented hair along the labia (11.9 years)

Accelerated: about 7.0 to 8.0 cm (2.8 to 3.2 in) per year

Clitoral enlargement

Labia pigmentation

Uterus enlargement

Breast tissue beyond areola without contour separation (12.4 years)

Hair is coarser, curled and pigmented; spreads across the pubes (12.7 years)

Peak velocity: about 8.0 cm (3.2 in) per year (12.5 years)

Axillary hair (13.1 years) Acne (13.2 years)

Projection of areola and papilla forms a secondary mound (13.1 years)

Adult-type hair but no spread to medial thigh (13.4 years)

Adult-type hair but no spread to medial thigh (13.4 years)

Menarch (13.3 years) Regular menses (13.9 years)

Adult breast contour with projection of papilla only (14.5 years)

Adult-type hair with spread to medial thigh but not up linea alba (14.6 years)

Cessation at about 16 years

Adult genitalia

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