• Primary care providers should be aware of secular trends in the timing and tempo of puberty, including variations between different racial and ethnic groups.

  • Pubertal staging should be a part of annual routine pediatric patient visits.

  • Children with normal variations in pubertal timing should be distinguished from patients with pathological precocious puberty.

  • Because immediate access to a pediatric endocrinologist may not always be possible or necessary, primary care providers should be familiar with the initial evaluation and counseling for children with early puberty.

After completing this article, the reader should be able to:

  • Describe the physiologic process of puberty, including the key factors that determine onset and tempo of puberty.

  • Document sexual maturity ratings and anticipate the course of pubertal progression.

  • Recognize normal variations of puberty, including benign premature thelarche and benign premature adrenarche.

  • Plan investigations according to a logical differential diagnosis for precocious puberty.

  • Identify when a patient should...

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