With increased growth velocity, pubertal status should be assessed. If signs of puberty are present, together with accelerated skeletal maturation, this should be investigated. Precocious sexual development (Fig. 14.32) should be differentiated from pseudoprecocious puberty where excessive androgen and oestrogen production results from a tumour in the ovary, testis, or adrenals, or to congenital adrenal hyperplasia. In precocious puberty, the linear growth and bone maturation are advanced, and height is often above average, although the final height is likely to be reduced.
