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J Korean Med Assoc > Volume 52(12); 2009 > Article
Journal of the Korean Medical Association 2009;52(12):1189-1200.
DOI: https://doi.org/10.5124/jkma.2009.52.12.1189   
Observed Trends for an Earlier Onset of Puberty: When is the Need for Treatment Indicated?
Jae Hyun Kim, Choong Ho Shin, Seong Yong Lee
1Department of Pediatrics, Seoul National University College of Medicine, Korea. chshinpd@snu.ac.kr
2Department of Pediatrics, Boramae Medical Center, Korea.
Abstract
Globally, there is a secular trend toward earlier puberty and an increased final height at adulthood. In Korea, there is a trend toward an earlier menarche in girls but insufficient data to evaluate secular trends in boys. A significant increase in height was observed in Koreans aged 0~20 years during 1965~2005. This trend has diminished, but growth maturation has accelerated in infants and young children. Genetic and environmental factors including nutritional status (e.g., obesity) contribute to these changes. Central precocious puberty results from the accelerated activation of the hypothalamic-pituitary-gonadal axis. Although the cut-off age is controversial, clinical evaluations should be conducted on girls with pubertal onset occurring younger than 8 years, and on boys younger than 9 years at least until further prospective studies define the norms for Korea. Management of precocious puberty depends on the underlying etiology, as accelerated puberty can lead to a reduced final adult height. Depot forms of GnRH agonists (GnRHas) are the standard treatment for some patients with central precocious puberty. These agents can help restore the normal adult height in both girls and boys when it might be compromised by rapidly progressive precocious puberty. However, in girls with slowly progressive precocious puberty or with the onset of puberty at 8~9.9 years of age (early normal puberty), GnRHa treatment might offer no benefit for attaining normal height. There is little evidence on whether psychosocial problems are associated with precocious puberty or are improved by GnRHa treatment.
Key Words: Puberty, Secular trend, Precocity
 
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