Table 1

Causes of early puberty

Central – gonadotropin dependentGonadotropin independent – peripheral oestrogen
IdiopathicThelarche (and variant)
Hypothalamic hamartomaOvary tumour or cyst (including McCune–Albright syndrome and massive ovarian oedema)
Optic glioma (NF)Drug/diet sources
Longstanding/severe peripheral secretionTesticle/liver tumours
Abnormal brain (hydrocephalus, septo-optic dysplasia)
CNS damage (infection/trauma/low dose irradiation)Gonadotropin independent – peripheral androgen
HCG production (CNS or peripheral tumours)Atypical CAH
HypothyroidismAdrenal 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.