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Are adrenal and ovarian function normal in true precocious puberty?

Generations of pediatric endocrinologists have reassured families that idiopathic complete precocious puberty (CPP) is a normal process happening early and that affected children are "capable of leading normal, well-adjusted lives and producing children" (1). The same has been said of the common incomplete forms of sexual precocity, idiopathic premature thelarche and premature pubarche. However, data are beginning to accumulate to suggest that this is not entirely true (2).

Some patients with premature thelarche develop CPP (3) and some with CPP have been reported to go on to develop polycystic ovary syndrome (PCOS) (4, 5). In addition, those patients whose premature pubarche is due to increased production of adrenal androgens (premature or exaggerated adrenarche) appear to be at high risk of developing a PCOS-like state of persistent functional ovarian hyperandrogenism with oligomenorrhea and hirsutism or acne at adolescence (6). In this issue evidence is now presented that exaggerated adrenarche is associated