Fifteen-minute consultation: the child with early pubic hair

Premature pubarche refers to the early appearance of pubic hair before 8 years of age in girls and 9 years in boys and is most commonly due to premature adrenarche.Premature adrenarche refers to the early appearance of clinical signs of adrenal androgen action, including pubic or axillary hair, body odour, acne, or mild seborrhoea. It is usually a benign variant of normal development. However, similar features may also reflect central precocious puberty, non-classical congenital adrenal hyperplasia, androgen-secreting tumours or exogenous androgen exposure. Distinguishing premature adrenarche from these conditions helps avoid unnecessary investigations while ensuring timely recognition of clinically significant endocrine pathology. This practical 15-minute consultation guide outlines a structured approach to history taking, examination, initial investigations, differential diagnosis and indications for specialist referral.