Female precocious puberty algorithm

Female < 8 years old

 Breast development
 Genital maturation
 Growth acceleration
 ±Pubic hair
 ±Menstruation

Precocious puberty

Bone age: advanced

 LH
 FSH
 ± Estradiol

LH > 0.83 LH < 0.83

Estradiol ? Estradiol ?

GnRH Stimulation test

LH > 5-8 LH < 5-8

Central Precocious puberty
Rasio LH:FSH >1 Rasio LH:FSH <1

Peripheral precocious puberty

Head MRI

Abdominal & pelvic USG

Lesions (-) Lesions (+)

Cafe au laite Ovarial cyst Tumor that

Idiopatik The cause is
triger the
Central nervous
gonad/gonadotr
system
McCune opin
Surgery
Albright
syndrome
Treat according Surgery
the etiology Radiation
Aromatase inhibitor Chemotherapy
Estrogen receptor
antagonist