Overview and treatment of precocious puberty

Puberty is a complex and coordinated biologic process of sexual development that leads to complete gonadal maturation and function, and attainment of reproductive capacity. The pubertal activation of pulsatile gonadotropin-releasing hormone (GnRH) secretion requires coordinated changes in excitatory and inhibitory neurotransmitters, growth factors, and a group of transcriptional regulators. Kisspeptin and its putative receptor, G protein-54 signaling complex, have recently emerged as essential gatekeepers of GnRH activation. Precocious puberty is defined as the onset of secondary sexual characteristics before the age of 8 years for girls and 9 years for boys. The prevalence of precocious puberty is rapidly increasing in Korea. Factors affecting early puberty include genetic traits, nutrition, and exposure to endocrine disrupting chemicals. Precocious puberty may cause psychosocial problems with inappropriate early biological maturation and significant impairment of final height due to accelerated bone maturation. In rapidly progressing central precocious puberty, GnRH agonists appear to increase final height without significant side effects, if administered in the early stages. Further large-scale randomized controlled studies of the long-term safety and efficacy of GnRH agonist treatment are needed.