Referred for Early Puberty: Preponderance

In tro duc ti on In girls, precocious puberty (PP) is defined as the onset of breast development under 8 years of age along with advancement of bone age (BA), increased growth velocity, and pelvic ultrasonography (USG) findings consistent with puberty. In most girls, central PP (CPP) is idiopathic and is caused by premature activation of the hypothalamic gonadotropin-releasing hormone (GnRH) pulse generator. Pubic hair can be the first sign of PP. CPP may lead to premature epiphyseal fusion and compromised final height (1,2) in addition to psychological stress (3,4). Thus, early initiation of treatment is of utmost importance (2). Premature pubarche (PPb) and premature thelarche (PT) are benign, normal variants that can resemble PP but are very slow or non-progressive conditions. PT refers to the isolate