Evidence-based recommendation for surveillance of central precocious puberty (CPP) (IGHGa) b

This page is part of the PanCare follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for central precocious puberty (CPP)?

CAYA cancer survivors below age 8 years (girls) or 9 years (boys) treated with or with a history of

  • radiotherapy to a volume exposing the HP region, including TBI
  • surgery near or within the HP region
  • CNS tumours near or within the HP region
  • hydrocephalus or cerebrospinal fluid shunt

When should surveillance for CPP be initiated?

For survivors treated with radiotherapy to a volume exposing the HP region, including TBI:

  • Initiate surveillance at 6 months from start of radiotherapy, even in the absence of symptoms c

For other survivors at risk for central precocious puberty:

  • Initiate surveillance from diagnosis of CNS tumour, surgery near or within the HP region, or occurrence of hydrocephalus or cerebrospinal fluid shunt

What surveillance modality should be used and at what frequency should it be performed?

All survivors at risk for CPP:

  • Relevant clinical history for symptoms of CPP
  • Physical examination for signs of CPP
  • Height velocity (height, expressed as standard deviation and plotted on a growth chart) in relation to parental height
  • Tanner stage (pubertal development and pubertal progression)
    every 6 months

Male survivors below 9 years exposed to gonadotoxic therapy d:

  • Morning testosterone (10 AM)
    every year

For how long should surveillance for HP axis problems be performed?

  • Until age 8 years in girls
  • Until age 9 years in boys

What should be done if abnormalities are identified?

  • Refer to a paediatric endocrinologist if there are clinical symptoms and signs suggestive for CPP

  • Counsel survivors with (a suspicion for) CPP regarding the benefits of treatment for central precocious puberty on overall health as well as the risk for short stature associated with untreated CPP, and assist them with coordinating and obtaining an early referral when appropriate


While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

a This recommendation reflects the recommendations of the preliminary evidence-based IGHG Hypothalamic-pituitary dysfunction guideline. The guideline will be published in a peer-reviewed journal soon.

b Further recommendations regarding height are specified in the Consensus-based recommendation for health promotion.

c Monitoring height and pubertal status at six months from the end of radiotherapy is desirable, as interpretation of growth and pubertal development requires multiple measurements over time. Oncology and primary care clinicians involved in the follow-up care of CAYA cancer survivors should be aware that central precocious puberty may already present in the first year after radiotherapy exposure, necessitating early referral.

d In children exposed to gonadotoxic agents, testicular volume may be unreliable and morning testosterone should be used as a screening modality.