[Acceleration of pubertal development]

Sexual precocity is defined as the appearance of physical signs of puberty at a time -3 SD before the mean age for the population, that is before 8 years for girls and 8.5-9.0 years for boys. The Authors discuss about etiology, therapeutic approach, indications for treatment, results and still open problems in this condition. From the pathogenetic point of view disorders that induce sexual precocity can be classified as gonadotropin-releasing hormone (Gn-RH) dependent or Gn-RH independent. Premature activation of the hypothalamic Gn-RH pulse generator may be induced by malformations, tumours and other neurogenic lesions of the CNS, while in more than 70% of patients the primary factor is not identifiable (idiopathic form). Idiopathic true precocious puberty is more frequent in females, whereas in males CNS lesions, especially neoplasms, are more prevalent. The main aims of therapy in precocious puberty are to inhibit puberty, to stop and possibly reverse the progression of secondary sex characteristics and particularly menses, to slow down skeletal maturation, to delay epiphyseas closure and consequently to improve final height, to preserve fertility, to improve psycho social well-being and naturally to treat the underlying cause, when known. Gonadotropin-releasing hormone agonists (Gn-RHa) are now the therapy of choice when the disease is Gn-RH dependent. They are effective both in arresting pubertal development and in improving final adult height. In selected cases with a great reduction of growth velocity an association with hGH therapy is possible. We must pay special attention to bone mineralization with this kind of treatment at this very delicate age.