Keyword: Bone Age

ABSTRACT: Central precocious puberty is an uncommon but important paediatrics endocrine condition that requires timely recognition and evaluation to prevent adverse auxological and psychosocial outcomes. We present the case of a 6-year-old girl with a 10-month history of progressive breast enlargement and pubic and axillary hair development. Clinical examination revealed markedly advanced secondary sexual characteristics, consistent with Tanner stage IV maturation. Endocrine evaluation demonstrated pubertal-range gonadotropin concentrations, and dynamic testing with a gonadotropin-releasing hormone agonist showed a pubertal luteinizing hormone response, supporting activation of the hypothalamic-pituitary-gonadal axis. Bone age assessment demonstrated advancement beyond chronological age, while pelvic ultrasonography showed pubertal uterine morphology. Brain magnetic resonance imaging revealed no hypothalamic-pituitary or other intracranial lesion. Following clinical, biochemical, radiological, and imaging assessment, a diagnosis of idiopathic central precocious puberty was made. The patient’s parents were counselled on the diagnosis, treatment options, expected benefits, and need for follow-up, and treatment with a gonadotropin-releasing hormone analogue was commenced. This case underscores the importance of a structured approach to children presenting with early progressive pubertal development, including careful clinical assessment, bone age evaluation, endocrine testing, pelvic imaging, and neuroimaging where indicated.