{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T23:01:46Z","timestamp":1781478106631,"version":"3.54.1"},"reference-count":13,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2003,1,1]]},"abstract":"<jats:p>Objective. The Lawson Wilkins Pediatric Endocrine Society recently issued new recommendations for the age at which puberty should be considered precocious, lowering the prevailing standards from 8 years to 7 years for white girls and to 6 years for black girls. The new recommendations were based on a single epidemiologic study that focused on the conditions of premature thelarche and premature adrenarche (both characterized by a single sign of puberty). Although the data were available, the authors did not comment on the low incidence of true precocious puberty (characterized by breast and pubic hair development) in their population. The hypothesis for the present study is that the new recommendations lead to underdiagnosis of endocrine pathology<\/jats:p>\n               <jats:p>Methods. Using 29 International Classification of Diseases, Ninth Revision codes for diagnoses known to be associated with precocious puberty, we identified 1570 patient visits to our outpatient pediatric endocrinology clinic of white girls aged 7 to 8 and black girls aged 6 to 8 during a 5-year period<\/jats:p>\n               <jats:p>Results. Of the 1570 patient visits, 223 unique patients were identified as having been referred for the sole finding of precocious pubertal development. These 223 patients carried no other endocrine diagnoses. Eleven patients (4.9%) were found to have no true breast buds and no terminally differentiated pubic hair. A total of 105 (47.1%) of 223 patients were found to have 2 signs of puberty, consistent with true precocious puberty according to the conventional guidelines of precocity of 8 years in girls. Overall, 12.3% of patients also had diagnoses of other endocrine conditions that included congenital adrenal hyperplasia, McCune-Albright syndrome, growth hormone deficiency, hypothyroidism, hyperinsulinism, pituitary adenoma, and neurofibromatosis. A total of 35.2% of girls with true precocious puberty exhibited bone ages &amp;gt;3 standard deviations above the mean, indicating markedly diminished growth potential<\/jats:p>\n               <jats:p>Conclusions. We conclude that signs of puberty in 6- to 8-year-old girls should not be considered normal or benign. Implementation of the new guidelines for the evaluation of puberty will result in failure to identify conditions that respond to early intervention.<\/jats:p>","DOI":"10.1542\/peds.111.1.47","type":"journal-article","created":{"date-parts":[[2004,8,14]],"date-time":"2004-08-14T00:43:47Z","timestamp":1092444227000},"page":"47-51","source":"Crossref","is-referenced-by-count":99,"title":["Are Pubertal Changes in Girls Before Age 8 Benign?"],"prefix":"10.1542","volume":"111","author":[{"given":"L. Kurt","family":"Midyett","sequence":"first","affiliation":[{"name":"From the Section of Endocrinology, Children\u2019s Mercy Hospital, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne V.","family":"Moore","sequence":"additional","affiliation":[{"name":"From the Section of Endocrinology, Children\u2019s Mercy Hospital, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill D.","family":"Jacobson","sequence":"additional","affiliation":[{"name":"From the Section of Endocrinology, Children\u2019s Mercy Hospital, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2003,1,1]]},"reference":[{"key":"2021120821093372200_R1","doi-asserted-by":"crossref","unstructured":"Herman-Giddens ME, Slora EJ, Wasserman RC, et al. Secondary sexual characteristics and menses in young girls seen in office practice: a study from the Pediatric Research in Office Settings network. Pediatrics.1997;99:505\u2013512","DOI":"10.1542\/peds.99.4.505"},{"key":"2021120821093372200_R2","doi-asserted-by":"crossref","unstructured":"Kaplowitz PB, Oberfield SE. Reexamination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society. Pediatrics.1999;104:936\u2013941","DOI":"10.1542\/peds.104.4.936"},{"key":"2021120821093372200_R3","doi-asserted-by":"crossref","unstructured":"Pathomvanich A, Merke DP, Chrousos GP. Early puberty: a cautionary tale. Pediatrics.2000;105:115\u2013116","DOI":"10.1542\/peds.105.1.115"},{"key":"2021120821093372200_R4","doi-asserted-by":"crossref","unstructured":"Rosenfield RL, Bachrach LK, Chernausek SD, et al. Current age of onset of puberty. Pediatrics.2000;106:622\u2013623","DOI":"10.1542\/peds.106.3.622"},{"key":"2021120821093372200_R5","unstructured":"Rogol A, Blizzard RM. Wilkins\u2019 The Diagnosis and Treatment of Endocrine Disorders in Childhood and Adolescence. Springfield, IL: Charles C Thomas; 1994"},{"key":"2021120821093372200_R6","doi-asserted-by":"crossref","unstructured":"Kaplowitz PB, Slora EJ, Wasserman RC, Pedlow SE, Herman-Giddens ME. Earlier onset of puberty in girls: relation to increased body mass index and race. Pediatrics.2001;108:347\u2013353","DOI":"10.1542\/peds.108.2.347"},{"key":"2021120821093372200_R7","unstructured":"Lee PA. Principles and Practice of Endocrinology and Metabolism. Philadelphia, PA: JB Lippincott; 1990"},{"key":"2021120821093372200_R8","doi-asserted-by":"crossref","unstructured":"Dimartino-Nardi J. Premature adrenarche: findings in prepubertal African-American and Caribbean-Hispanic girls. Acta Paediatr Suppl.1999;88:67\u201372","DOI":"10.1111\/j.1651-2227.1999.tb14406.x"},{"key":"2021120821093372200_R9","unstructured":"Ibanez L, Potau N, Dunger D, de Zegher F. Precocious pubarche in girls and the development of androgen excess. J Pediatr Endocrinol Metab.2000;13(suppl 5):1261\u20131263"},{"key":"2021120821093372200_R10","doi-asserted-by":"crossref","unstructured":"Ibanez L, Dimartino-Nardi J, Potau N, Saenger P. Premature adrenarche: normal variant or forerunner of adult disease?Endocr Rev.2000;21:671\u2013696","DOI":"10.1210\/edrv.21.6.0416"},{"key":"2021120821093372200_R11","doi-asserted-by":"crossref","unstructured":"Silfen ME, Manibo AM, McMahon DJ, Levine LS, Murphy AR, Oberfield SE. Comparison of simple measures of insulin sensitivity in young girls with premature adrenarche: the fasting glucose to insulin ratio may be a simple and useful measure. J Clin Endocrinol Metab.2001;86:2863\u20132868","DOI":"10.1210\/jc.86.6.2863"},{"key":"2021120821093372200_R12","doi-asserted-by":"crossref","unstructured":"Herman-Giddens ME, Bourdony C, Slora E, Wasserman R. Early puberty: a cautionary tale. Pediatrics.2001;107:609\u2013610","DOI":"10.1542\/peds.107.3.609"},{"key":"2021120821093372200_R13","unstructured":"MacMahon B. Age at Menarche: United States, 1973. Hyattsville, MD: National Center for Health Statistics; 1974. DHEW Publ. No. [HRA] 74-1615"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/111\/1\/47\/1006226\/pe0103000047.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/111\/1\/47\/1006226\/pe0103000047.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T01:09:30Z","timestamp":1639012170000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/111\/1\/47\/28518\/Are-Pubertal-Changes-in-Girls-Before-Age-8-Benign"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,1,1]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2003,1,1]]},"published-print":{"date-parts":[[2003,1,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.111.1.47","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,1,1]]}}}