II. Causes: GnRH dependent (True or Central): Complete Isosexual

  1. Idiopathic
  2. CNS Lesion (e.g. pituitary tumor)
  3. Secondary to GnRH independent Precocious Puberty
  4. Hypothyroidism (unclear cause)
  5. Chronic Adrenal Insufficiency

III. Causes: GnRH independent (Peripheral - always abnormal)

  1. Adrenal Causes
    1. 21-OH deficiency
    2. 11-OH deficiency
    3. Results
      1. Girls: contrasexual
      2. Boys: isosexual
    4. Tumor: Contrasexual OR Isosexual
  2. Gonadal Cause
    1. McCune-Albright Syndrome (Isosexual)
      1. Polyostotic fibrous dysplasia
      2. Cafe Au Lait spots
      3. Precocious Puberty
      4. Associated with Hyperthyroidism, Cushing's Syndrome
    2. Familial Male (Testotoxicosis, Isosexual)
    3. Tumor (Isosexual or Contrasexual)
  3. Miscellaneous Cause
    1. Ectopic hCG Secreting tumor (Isosexual in boys)
    2. Extraglandular aromatization (Contrasexual in boys)
    3. Factitious (Isosexual or Contrasexual)

IV. Causes: Partial Sexual Development Causes

  1. Benign Premature Thelarche
    1. Isolated Breast development as early as
  2. Benign Premature Adrenarche
    1. Isolated pubic hair develops under age 6 years

V. Causes: Contrasexual Development Causes

  1. Boys
    1. Estrogen-Secreting adrenal tumor
  2. Girls
    1. Excessive pubic hair
      1. Adrenal hyperplasia
      2. Benign Premature Adrenarche
      3. Polycystic Ovary Disease (older girls)
    2. Virilization (clitoromegaly and increased Muscle)
      1. Ovarian tumor
      2. Adrenal tumor
      3. Cushing's Syndrome
      4. Hyperprolactinemia
      5. Acromegaly
      6. Exogenous androgens

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