Review of precocious puberty: Part III - Premature thelarche and premature adrenarche. Variations of normal?

It has been recently recommended that puberty be considered early if it begins before age 6 in African-American girls and before age 7 in Caucasian girls. Although this recommendation is based on a substantial clinical study, concerns remain as to whether the now larger population of girls defined as normal contains individuals with a pathologic process as part of their early development. Important questions also arise as to the mechanisms for earlier puberty and potential health consequences of earlier sexual maturation. This paper will review the new definitions proposed for the onset of normal puberty and will review recent developments regarding the clinical course, potential complications, and proposed molecular mechanisms for premature thelarche and adrenarche. While investigators continue to search for the underlying pathophysiology for these clinical findings, it seems prudent to continue to evaluate girls presenting with early pubertal signs and to provide close clinical follow-up for potential long-term complications.