Table 4.

Potential risk factors affecting pubertal development.

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