Precocious |
Gonadotropin-dependent (central precocious puberty) |
Brain pathology (e.g., hypothalamic hamartoma, tumors, hydocephalus, severe head trauma) |
Hypothyroidism, untreated |
Gonadotropin-independent precocious puberty |
McCune-Albright syndrome in girls |
Familial male precocious puberty (testotoxicosis) |
Tumors (ovarian, adrenocortical, Leydig cell, chorionic gonadotropin-secreting tumors) |
Exogenous pharmaceutical estrogen or androgen use |
Isolated premature thelarche, premature pubarche/adrenarche, premature menarche |
Delayed |
Poor nutrition |
Chronic illness |
Constitutional growth delay |
Intense physical training |
General categories associated with altered pubertal development |
General nutrition |
General health |
Brain injury |
Obesity |
Socioeconomic status |
Immigration/adoption |
Race/ethnicity |
Pharmaceuticals [estrogenic, androgenic, estrogen blocker (i.e., aromatase inhibitors), and androgen blocker (e.g., finasteride, flutamide)] |
Genetics |
Gestational age |