Precocious Puberty in Girls Referral Guidelines

Girls over 8 Years

Clinical Findings

Breast development with one or more of the following signs:

  • Progressing over time
  • Accelerated growth
  • Vaginal bleeding
  • Headaches and/or visual changes
  • Multiple Café au lait spots > 1.5 cm (possible McCune Albright Syndrome)

Referral Timeframe

URGENT: Call MD on-call to discuss and start treatment.
On-Call Phone #
Day: (512) 628-1830
After Hours: (512) 323-5465

Pre-Referral Workup

  • Bone age
  • TSH and T4 or Free T4 by dialysis
  • Pediatric LH (CPL 2776, Esoterix 500234, Lab Corp 502286)
  • Pediatric FSH (CPL 2700, Esoterix 500192, LabCorp 502280)
  • Ultrasensitive Estradiol (CPL 5678, Esoterix 500152, Lab Corp 500108)
  • Please get labs at 8am

Referral Requirements

  • Growth chart
  • Bone age results- Please have parent bring a copy of film/CD to appointment.
  • Lab results
  • Relevant clinical notes with physical examination including Tanner stage.

Girls 6-8 Years

Clinical Findings

Breast development without the above signs

Referral Timeframe

Routine

Pre-Referral Workup

Same as above

Referral Requirements

Same as Above

Girls 2-6 Years

Clinical Findings

Breast development without the above signs

Referral Timeframe

URGENT: Call MD on-call to discuss and start treatment.

Pre-Referral Workup

Same as above

Referral Requirements

Same as Above

Girls under 2 Years

Clinical Findings

Breast development without the above signs

Referral Timeframe

May NOT need referral

Pre-Referral Workup

None

Referral Requirements

Call Endocrine with any questions or concerns

Facts to Remember

  • Standard LH, FSH, Estradiol or Testosterone assays are not reliable for children, please use test codes provided.
  • Consider imaging testing such as pelvic ultrasound or brain and pituitary MRI if warranted.
  • In benign premature thelarche, the nipples are not usually dark or enlarged as seen in precocious puberty.
  • Fine downy and non-pigmented short hair is not considered secondary sexual pubic hair.
  • Pubic hair on the suprapubic area is more indicative of precocious puberty than hair on the labial majora or scrotum.