Introduction: Precocious puberty (PP) is defined as the onset of secondary sexual characteristics before the age of 8 years in girls and before 9 years in boys. The main clinical challenge is the differentiation between central precocious puberty (CPP), caused by premature activation of the hypothalamic–pituitary–gonadal axis, peripheral precocious puberty (PPP), and benign variants of pubertal development. Aim: To systematize current diagnostic approaches, evaluate the effectiveness of therapeutic protocols, and accurately differentiate pathological conditions from benign developmental variants. Diagnostics: The diagnostic algorithm is primarily based on anthropometric assessment (growth velocity 7 cm/year) and radiological evaluation of bone maturation, where advanced bone age ≥ 2 SD represents a key indicator of progression. Additional criteria include pelvic ultrasound findings, with uterine volume 1.8 ml suggestive of pubertal activation. The gold standard for diagnosis remains the gonadotropin-releasing hormone (GnRH) stimulation test, with a peak LH value 5 IU/L confirming CPP. A special focus is placed on differentiating progressive forms from benign variants such as isolated thelarche and adrenarche, in order to avoid unnecessary therapeutic intervention. Treatment: Modern management of CPP involves the use of GnRH agonists (triptorelin, leuprolide) in depot formulations, which suppress pubertal progression by desensitizing pituitary GnRH receptors. Conclusion: Early diagnosis and timely initiation of therapy result in a significant improvement in final adult height (average gain of 0.63 SDS). Effective management requires an interprofessional approach and clear differentiation between normal developmental variants and pathological entities.
Jelenković et al. (Thu,) studied this question.