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Just published June 13th, 2026, the Endocrine Society’s newest guideline on Central Precocious Puberty.

The objective of this guideline was to develop evidence-based recommendations related to the diagnosis and treatment of central precocious puberty, or CPP. 

In today’s rapid update, we’ll just be going over the key recommendations so for the full guideline, make sure to check it out on guidelinecentral.com

Let’s get started. 

  • In girls who present with thelarche between ages 7.0 and 8.0 years, the guideline suggests watchful waiting via periodic physical examinations rather than immediately performing evaluation with laboratory testing and/or radiologic imaging
  • In girls younger than age 7 years with initial breast development, the guideline suggests a 4- to 6-month period of observation to differentiate unsustained or slowly progressive puberty from rapidly progressive puberty before starting diagnostic evaluation.
  • In girls and boys with evidence of precocious puberty, the guideline suggests an initial evaluation with a basal luteinizing hormone concentration by ultrasensitive assay, rather than initially performing a gonadotropin-releasing hormone/gonadotropin-releasing hormone agonist stimulation test, in order to distinguish those with central precocious puberty from those without.
  • In girls ages 6.0 to 8.0 years and boys ages 8.0 to 9.0 years with central precocious puberty and without central nervous system findings, the guideline suggests that brain MRI should not be routinely performed.
  • For children with central precocious puberty, the guideline suggests against routine genetic testing.
  • For many children with central precocious puberty, the guideline suggests gonadotropin-releasing hormone agonist treatment, although certain patient subgroups may not achieve net benefit with such treatment.
  • In patients with central precocious puberty who will use a long-acting gonadotropin-releasing hormone agonist in the long term, the guideline suggests initiating therapy with the long-acting gonadotropin-releasing hormone agonist preparation rather than initiating therapy with a monthly gonadotropin-releasing hormone agonist.
  • In children being treated for central precocious puberty with a gonadotropin-releasing hormone agonist, the guideline suggests against routine biochemical testing to monitor pubertal suppression.
  • In children with central precocious puberty, the guideline suggests against the routine addition of growth hormone to gonadotropin-releasing hormone agonist therapy.
  • In children being treated for central precocious puberty, the guideline suggests against routinely continuing gonadotropin-releasing hormone agonist treatment beyond chronological age 10.0 to 11.0 years (girls) or 11.0 to 12.0 years (boys) and/or bone age 11.0-12.0 years (girls) or 12.0-13.0 years (boys).

And there you have it. Make sure to check out the full guideline from the Endocrine Society and other related clinical decision support tools at guidelinecentral.com.

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