Precocious puberty : Classification

Precocious puberty, characterized by the early onset of secondary sexual characteristics, represents a significant deviation from the norm in the timing of pubertal development. This condition is broadly classified into two main categories based on the underlying mechanisms: Gonadotrophin-dependent precocious puberty, also known as central or true precocious puberty, and Gonadotrophin-independent precocious puberty, referred to as pseudo or false precocious puberty. The former involves the premature activation of the hypothalamic-pituitary-gonadal (HPG) axis leading to an early but otherwise normal puberty process. In contrast, the latter is triggered by factors external to the HPG axis, typically involving the production of sex hormones from sources other than the gonads, such as adrenal glands or hormone-secreting tumors, without the preceding activation of the HPG axis.

In males, precocious puberty is less common and usually indicative of an organic pathology. The clinical presentation can vary, with bilateral testicular enlargement pointing towards a central cause related to gonadotrophin release, while unilateral enlargement suggests a gonadal tumor. Small testes might indicate an adrenal origin, such as a tumor or hyperplasia, leading to excess sex hormone production independent of gonadotrophin stimulation.

Understanding the classification and specific manifestations of precocious puberty is crucial for clinicians to undertake...