Generally, the hypothalamic-pituitary axis is prepubertal, with ovarian cysts accounting for the sexual maturation. These conditions may herald the onset of precocious puberty, but precocious pubarche, adrenarche, and thelarche may occur independently of any further development. When these conditions occur without pubertal progress, they are generally benign. Close follow-up for all these conditions is warranted, especially to assess progression of pubertal development. The incidence of true precocious puberty is 2 to 5 times greater in females.
Girls develop breasts and pubic and axillary hair.
Body odor and acne, as well as behavior changes, may be present in both sexes. Linear growth is initially rapid in both sexes, but the adult height is shortened by premature closure of the epiphyses. Testicular or ovarian enlargement, which occurs in true precocious puberty, is usually absent in pseudoprecocious puberty. However, ovarian cysts may occur in some cases of McCune-Albright syndrome or in association with sporadic menstruation. Laboratory evaluation depends on the initial clinical assessment after a thorough history and physical examination.