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Although precocious puberty has standard clinical definitions and diagnostic tests are improving, the management of children who have signs of early puberty has become more complex in some ways during the last decade than ever before. This review illustrates how an understanding of the anatomy and physiology of puberty forms the foundation for managing children who experience puberty early.

A 4-year-old female has developed pubic hair in the past 3 months and has had an adult body odor for 6 months. She is otherwise healthy and has no pertinent findings on medical and surgical history. Her height and weight are just above the 97th percentile for age, and her physical examination reveals Sexual Maturity Rating (SMR) 2 breast and pubic hair development.

By convention, normal puberty begins between ages 8 and 12 years in girls and between 9 and 14 years...

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