Central precocious puberty: an Endocrine Society clinical practice guideline

Girls with thelarche (Tanner B2) at ages 7.0–8.0 years: suggest watchful waiting via periodic physical examinations (every 4-6 months) rather than immediate laboratory testing or radiologic imaging

All girls with breast development (Tanner B2) before age 7 years: suggest first observing for 4 to 6 months to differentiate unsustained or slowly progressive vs rapidly progressive puberty

Hormonal evaluation: suggest starting with ultrasensitive basal luteinizing hormone (LH) concentration rather than routine gonadotropin-releasing hormone (GnRH)/GnRH/GnRH agonist (GnRHa) stimulation testing for all patients

Suggest brain MRI not be routinely performed in girls ages 6.0 to 8.0 years and boys ages 8.0 to 9.0 years without central nervous system symptoms

Suggest against routine genetic testing in central precocious puberty (CPP); consider genetic testing (eg, MKRN3 sequencing) in familial CPP through shared decision-making

Suggest GnRHa treatment for many children with CPP; some subgroups (eg, older girls with slowly progressive CPP) may be less likely to receive a net benefit

Suggest initiating GnRHa with the formulation (such as a longer-acting formulation) anticipated to be used long-term, rather than always starting with a monthly injectable

Suggest against routine addition of GH therapy to increase adult height

Suggest against routine biochemical testing (eg, LH, sex steroids) to monitor pubertal suppression on GnRHa; reserve it to confirm clinically suspected treatment failure

Suggest against routinely continuing GnRHa beyond chronologic age 10.0 to 11.0 years (girls) or 11.0 to 12.0 years (boys) and/or bone age 11.0 to 12.0 years (girls) or 12.0 to 13.0 years (boys)