In true precocious puberty, the secondary sexual characteristics of both boys and girls appear before the normal age of puberty (earlier than 8 years old for girls and 9 years old for boys), but the procedure is similar to that of normal development. The clinical manifestations of girls are firstly breast development, with nucleus formation and local elevation into a small mound, while the nipple and areola gradually increase in size. At the middle stage of breast development, pigmentation of the areola and nipple appears. At the same time, since the early stage of breast development, the growth rate is accelerated, and the growth peak of puberty is also advanced, the subcutaneous fat increases significantly, and the height and weight often exceed those of children of the same age. Most of the pubic hairs appear about one year after breast development, while the axillary hairs appear even later, often after menarche. The internal and external genitalia are enlarged, there is pigmentation of the labia minora, and white vaginal discharge appears. The age of menarche is early and menstruation with ovulation may occur. The above development process is continuous and progressive until the final sexual maturity and fertility, but the speed of the process varies from person to person. In true precocious puberty, both male and female, the bone age is often significantly higher than the actual age, and thus the epiphysis matures too quickly and heals early, which will eventually affect the adult lifetime height. Concubine Li, Department of Endocrinology, Shanghai Children’s Hospital
Enlarged testicles are the first important feature of true precocious puberty in males, followed by penile growth, enlarged scrotum, increased scrotal skin folds, deepened pigmentation, pubic hair growth, increased penile erection, seminal emission and even sperm growth. The order of appearance of male secondary sexual characteristics such as axillary hair, beard, throat nodes, and voice change is also similar to that of normal pubescent children, only at an earlier age. In the middle stage of testicular development, the growth rate of the child is accelerated, but the increased bone maturation will also lead to premature healing of the epiphysis, which will shorten the time frame for height growth and may lead to short stature. Children with true precocious puberty, both male and female, have physical and sexual characteristics similar to those of older children with normal puberty, but their intellectual development level is still consistent with their actual age.