Causes of early puberty
| Central – gonadotropin dependent | Gonadotropin independent – peripheral oestrogen |
|---|---|
| Idiopathic | Thelarche (and variant) |
| Hypothalamic hamartoma | Ovary tumour or cyst (including McCune–Albright syndrome and massive ovarian oedema) |
| Optic glioma (NF) | Drug/diet sources |
| Longstanding/severe peripheral secretion | Testicle/liver tumours |
| Abnormal brain (hydrocephalus, septo-optic dysplasia) | |
| CNS damage (infection/trauma/low dose irradiation) | Gonadotropin independent – peripheral androgen |
| Adoption | Adrenarche |
| HCG production (CNS or peripheral tumours) | Atypical CAH |
| Hypothyroidism | Adrenal tumour (including Cushing's) |
| Testicular tumour | |
| Testotoxicosis and McCune–Albright syndrome |
CAH, congenital adrenal hyperplasia; CNS, central nervous system; HCG, human chorionic gonadotropin; NF, neurofibromatosis.