Central Precocious Puberty (CPP)

Precocious puberty is defined as the onset of developmental signs of sexual maturation earlier than would be expected based on population norms. This is typically delineated as puberty onset before 8 years in girls and 9 years in boys. In its most common form, central precocious puberty (CPP), sexual maturation proceeds from a premature activation of the hypothalamic–pituitary–gonadal (HPG) axis3. The HPG axis is active during infancy, dormant during childhood, and reactivated at the onset of puberty.

The epidemiology of CPP is somewhat nebulous, with a commonly cited prevalence range of 1 in 5000 to 1 in 10,000 children7. CPP is known to occur more frequently in girls than in boys and has different predominant causes for each sex. Idiopathic CPP, without an identifiable predisposing condition, accounts for the majority of cases of precocious puberty in girls, but is less frequent in boys4,6,8. Central nervous system findings such as tumors and congenital malformations are more frequently observed in boys who present with central precocious puberty5,6,7. It is estimated that two thirds of precocious puberty cases in boys are due to neurological abnormalities5. The likelihood of an organic cause for CPP is greater in patients who present at younger ages6,7.


  1. A Pediatrician's Guide to Central Precocious Puberty, Gad B. Kletter, Karen O. Klein and Yolanda Y. Wong CLIN PEDIATR published online 14 July 2014. Accessed October 22, 2014.
  2. Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/precocious-puberty/basics/causes/con-20029745.
  3. Saenger P. Definition, etiology and evaluation of precocious puberty. http://www.uptodate.com/contents/definition-etiology-and-evaluation-of-precocious-puberty? Accessed October 22, 2014.
  4. Mogensen SS, Aksglaede L, Mouritsen A, et al. Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty. J Clin Endocrinol Metab. 2011;96:1393-1401. Accessed October 22, 2014.
  5. Brito VN, Latronico AC, Arnhold IJ, Mendonça BB. Update on the etiology, diagnosis and therapeutic management of sexual precocity. Arq Bras Endocrinol Metab. 2008;52:18-31. Accessed October 22, 2014.
  6. Carel JC, Leger J. Clinical practice. Precocious puberty. N Engl J Med. 2008;358:2366-2377. Accessed October 22, 2014.
  7. Partsch CJ, Sippell WG. Treatment of central precocious puberty. Best Pract Res Clin Endocrinol Metab.2002;16:165-189. Accessed October 22, 2014.
  8. Jakubowska A, Grajewska-Ferens M, Brzewski M, Sopyło B. Usefulness of imaging techniques in the diagnostics of precocious puberty in boys. Pol J Radiol. 2011;76:21-27. Accessed October 22, 2014.

Additional Resources

The following groups are dedicated to the education and assistance of patients that suffer from CPP. Find out more about CPP by visiting these websites:


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