Breast development in girls before age 8 is considered as precocious puberty. This is related to the first stage of puberty which is gonadarche and is related to the activation of estrogen production in the ovaries as signals initiated from the hypothalamic portion of the brain are sent to the pituitary which then are relayed to the ovaries in order to produce estrogen. Estrogen causes breasts to develop. Additionally bone development has been used in the criteria.

The second stage of puberty is adrenarche which has to do with adult type body odor and development of hair in the arm pits and pubic area. This is initiated by the activation of the adrenal androgen levels as prompted by the hypothalamus portion of the brain signals the pituitary. If there are seizures, headaches or visual changes a brain related issue is considered. In some cases an external stimulus such as hormone gel or cream might be responsible. Products that contain placental extracts, tea tree oil or lavender oil could also be related to precocious puberty.

The accelerated bone development is evident in height measurements. If height increases by more than 6 cm a year this is usually consistent with early puberty. If a young girl has not started to develop breasts but has the characteristics of premature adrenarche, it could be related to insulin resistance, obesity and high insulin levels. Some of these girls could later develop PCOS (polycystic ovarian syndrome).

Girls with premature adrenarche without early onset of breast development could be prone to psychiatric problems. Some of these girls who were small at birth could en up starting their periods early and might end up short, since the early onset of their menses result in the early epiphyseal maturation and therefore short stature. If estrogen levels are high without high gonadotropin LH and FSH levels would be related to an ovarian cyst or tumor. LH and FSH levels are low with PPP (precocious peripheral puberty) but elevated with CPP (central precocious puberty). If the attainment of adult height potential is wanted in cases of CPP the use of GnRH analogs are considered to help delay the onset of puberty.


Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin- releasing hormone analogs in children. Pediatrics.2009;123(4):e752-e762.