Precocious puberty
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Girl: breast development before age 8
Laboratory tests
- LH (ultrasensitive basal level)
- FSH
- GnRH stimulation test (if basal LH low and clinical picture suggestive; straight away according to the Pas à Pas guide)if neededNext step of the Endocrine Society (2026) when the ultrasensitive basal LH is low but the clinical picture suggests puberty, especially if it is progressing fast [2]. French position: the Pas à Pas (French Society of Paediatrics, 2017) indicates it from the outset, by measuring LH and FSH after intravenous LHRH, a central response being defined by LH > 6 mIU/mL [3].
- Oestradiol
- TSH (to rule out hypothyroidism)if needednon-French guidelineThe American family medicine reviews (AAFP, 2017 and 2025) include thyroid tests in the initial work-up of precocious puberty [4,5]: hypothyroidism can be accompanied by breast or testicular development and is one of the causes to rule out [4]. Level C recommendation (expert consensus) [5]. The commentaries of the French Pas à Pas do not mention it [3].
Boy: testicular enlargement before age 9
Laboratory tests (between 7 am and 11 am)
- LH (ultrasensitive basal level)
- FSH
- GnRH stimulation test (if basal LH low and clinical picture suggestive; straight away according to the Pas à Pas guide)if neededNext step of the Endocrine Society (2026) when the ultrasensitive basal LH is low but the clinical picture suggests puberty, especially if it is progressing fast [2]. French position: the Pas à Pas (French Society of Paediatrics, 2017) indicates it from the outset, by measuring LH and FSH after intravenous LHRH, a central response being defined by LH > 6 mIU/mL [3].
- Serum testosterone
- TSH (to rule out hypothyroidism)if needednon-French guidelineThe American family medicine reviews (AAFP, 2017 and 2025) include thyroid tests in the initial work-up of precocious puberty [4,5]: hypothyroidism can be accompanied by breast or testicular development and is one of the causes to rule out [4]. Level C recommendation (expert consensus) [5]. The commentaries of the French Pas à Pas do not mention it [3].
- β-hCG (if testosterone raised with low LH)if needednon-French guidelineIn boys, the American AAFP review (2017) lists hCG among the tests to do depending on the orientation: a high level points to an hCG-secreting germ cell tumour, a cause of peripheral precocious puberty, suggested by a low LH with high sex steroids [4]. The commentaries of the French Pas à Pas do not mention it [3].
Pubic hair or signs of virilisation, without breast development or testicular enlargement
Laboratory tests
- Total testosterone
- DHEA sulfate (DHEA-S)
- Delta-4-androstenedione
- 17-hydroxyprogesterone
Sources (7)
- Teilmann G, Pedersen CB, Jensen TK, Skakkebaek NE, Juul A. Prevalence and incidence of precocious pubertal development in Denmark: an epidemiologic study based on national registries. Pediatrics 2005;116(6):1323-1328.
- Latronico AC, Roberts SA, Alonzo M, et al. Central precocious puberty: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2026;111(8):2101-2144.
- CONDUITE À TENIR DEVANT UN DÉVELOPPEMENT PUBERTAIRE PRÉCOCE
- Klein DA, Emerick JE, Sylvester JE, Vogt KS. Disorders of Puberty: An Approach to Diagnosis and Management. Am Fam Physician. 2017;96(9):590-599 (article signalé par l'AAFP comme remplacé par une revue de 2025).
- Brown EE, Fogleman CD. Disorders of Puberty: Common Questions and Answers. Am Fam Physician. 2025;112(5):513-521C.
- Propositions portant sur le dépistage individuel chez l’enfant de 7 à 18 ans, destinées aux médecins généralistes, pédiatres et médecins scolaires
- Puberté normale et pathologique Item 34