Precocious puberty (complete, partial).

Two decades ago, the diagnosis of premature sexual development was considered to be simple; the conditions that were recognised were either central precocious puberty, isolated premature thelarche or an adrenal aetiology. The use of pelvic ultrasound and gonadotrophin-releasing hormone (GnRH) analogue treatment was to completely alter our understanding of these disorders. Pelvic ultrasound led to differentiating ovarian appearances in conditions such as McCune-Albright syndrome and the variation in ovarian maturation in premature thelarche and central precocious puberty. Failure to respond to GnRH analogue therapy in children with precocious puberty led to the concept of gonadotrophin-independent precocious puberty (GIPP). During the 1980s, several variants of premature sexual maturation were described and this was important, both for the natural history of these conditions and the requirement for therapy. Adrenal lesions causing sexual maturation are included in this chapter for completeness. Their diagnosis and management is considerably simpler than premature sexual maturation of a gonadal aetiology.