Clinical and Diagnostic Spectrum of Girls Evaluated for Suspected Precocious Puberty: A Single-Center Study

Objective: To evaluate the clinical, anthropometric, biochemical, and imaging characteristics of girls presenting with suspected precocious puberty and identify the key parameters that distinguish central precocious puberty (CPP) from benign pubertal variants. Methods: Between 2024 and 2025, 231 girls were retrospectively assessed at a single center and categorized into six diagnostic groups: central precocious puberty (CPP), rapidly progressing early puberty (R-EP), slowly progressing early puberty, premature thelarche, premature adrenarche, and normal. Clinical, anthropometric, laboratory, imaging, and treatment data were compared between the groups. Results: Age at presentation was significantly lower in the CPP and premature thelarche groups (p<0.001). Breast development was the most common presenting symptom. Advanced breast/pubic hair stages and more frequent axillary hair were observed in the CPP group, whereas early stages predominated in the benign variants (p<0.001). Basal LH and estradiol levels were significantly higher in the R-EP group (p<0.001). Pelvic ultrasonography revealed significantly larger uterine lengths and ovarian volumes in the CPP group (p<0.001). All pituitary MRIs were normal, except in three cases with clinically insignificant microadenomas. GnRH analog therapy was initiated in all patients with CPP and in 63.6% of those with rapidly progressing early puberty. Conclusion: Most referrals for suspected early puberty were benign variants. A multidimensional diagnostic approach is critical to avoid unnecessary intervention. In contrast, timely diagnosis and treatment of CPP are essential to preserve long-term growth and improve psychosocial outcomes. Our findings further support the selective use of neuroimaging and the need for individualized treatment.