Evaluation and management of precocious puberty.

Genetic and environmental factors are implicated in the timing of puberty (1). Human studies have shown a relationship between body mass index or body fat, dietary and physical activity with the timing of puberty (2, 3, 4). More recently a G-protein coupled receptor, GPR54 and its ligand Kisspeptin have been identified as important signals in pubertal induction (5). The role of leptin in the pubertal induction is permissive rather than definitive and there are many unanswered questions in relation to role of leptin (6).