Q. Is clinical evaluation helpful in diagnosis ?
A. Careful history taking and detailed physical examination are important. Early age of onset and rapid progression may favor hypothalamic hamartoma; delayed milestones may signify congenital abnormalities or perinatal brain damage while regression may suggest postnatal intracranial infections or trauma. Symptoms and signs of increased intracranial pressure favor the possibility of space occupying lesion. Family history of early puberty in mother or close female relatives favor familial predisposition.

Physical examination should assess pubertal staging which is important in management and follow up, physical measurements, growth velocity (if previous height is available) and growth status as well as careful general, systemic and CNS examination are extremely important in arriving at a diagnosis.

It is important to distinguish TPP from other forms of incomplete or pseudosexual precocity of peripheral origin as the underlying cause and management differ. More than one sign of sexual maturation with accelerated growth velocity, physical growth and advanced bone age is indicative of the central from of TPP. Early TPP is often indistinguishable from premature thelarche and often a policy of wait and watch and follow up evaluation has to be adopted. Occasionally isolated breast development may persist for six months or more hence diagnostic difficulties arise in distinguishing early CPP from premature thelarche.

In boys examination of the gonads is very helpful; bilateral enlargement favors CPP while as lack of it in presence of other signs of sexual precocity is seen with adrenal cause such as CAH. Asymmetrical enlargement of testis indicates testicular pathology such as a functioning testicular tumor, which is rare.