Puberdade precoce central fatores de risco, diagnóstico e tratamento na população pediátrica
DOI:
https://doi.org/10.36557/2674-8169.2026v8n10p1389-1405Palavras-chave:
puberdade precoce, diagnóstico, tratamento farmacológico, obesidade pediátricaResumo
A puberdade precoce central (PPC) decorre da ativação antecipada do eixo hipotálamo–hipófise–gônadas e requer distinção de variantes isoladas do desenvolvimento e de formas periféricas de precocidade sexual. O objetivo desta revisão foi discutir fatores de risco, investigação diagnóstica e tratamento da PPC na população pediátrica, contextualizando a contribuição da adiposidade e dos mecanismos neuroendócrinos. Trata-se de revisão narrativa, com seleção intencional de estudos e diretrizes, prioridade para publicações desde 2021 e retenção de trabalhos fundamentais anteriores. A síntese diferencia causas orgânicas e genéticas de associações epidemiológicas com maturação antecipada. A obesidade relaciona-se a marcos puberais mais precoces, sobretudo em meninas, mas não estabelece o diagnóstico de PPC. A avaliação integra história clínica, progressão dos caracteres sexuais, velocidade de crescimento, idade óssea e investigação hormonal, com exames etiológicos selecionados conforme a apresentação. O tratamento com agonistas do hormônio liberador de gonadotrofinas deve considerar progressão, potencial de crescimento e benefício esperado, em decisão compartilhada com a família. Conclui-se que o cuidado exige confirmação diagnóstica e acompanhamento individualizado, evitando tanto atribuir precocidade sexual exclusivamente ao excesso de peso quanto indicar bloqueio hormonal apenas pelo critério etário.
Palavras-chave: Puberdade Precoce; Diagnóstico; Tratamento Farmacológico; Obesidade Pediátrica
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ARGENTE, J. et al. Molecular basis of normal and pathological puberty: from basic mechanisms to clinical implications. The Lancet Diabetes & Endocrinology, v. 11, n. 3, p. 203-216, 2023. DOI: https://doi.org/10.1016/S2213-8587(22)00339-4.
BENSON, T. E. et al. Pubertal timing and tempo and depression risk in adolescent boys and girls: a Danish population-based cohort study. Journal of Affective Disorders, v. 412, art. 122020, 2026. Publicação on-line: 29 maio 2026. DOI: https://doi.org/10.1016/j.jad.2026.122020.
BRASIL. Ministério da Saúde. Protocolo clínico e diretrizes terapêuticas da puberdade precoce central. Brasília, DF: Ministério da Saúde, 2022. Portaria Conjunta nº 13, de 27 de julho de 2022. Disponível em: https://www.gov.br/saude/pt-br/assuntos/pcdt/p/puberdade-precoce-central/view. Acesso em: 14 out. 2026.
BRIX, N. et al. Childhood overweight and obesity and timing of puberty in boys and girls: cohort and sibling-matched analyses. International Journal of Epidemiology, v. 49, n. 3, p. 834-844, 2020. DOI: https://doi.org/10.1093/ije/dyaa056.
COELHO E OLIVEIRA, K.; ELIAS, L. L. K.; ANTONINI, S. R. R. The complex interaction between obesity and puberty and its implications for pubertal timing: a review of recent evidence. Endocrine Connections, v. 15, n. 3, art. e260069, 2026. DOI: https://doi.org/10.1530/EC-26-0069.
FENG, W.; REN, C. The relationship between childhood obesity and male puberty development: a systematic review and meta-analysis. Frontiers in Endocrinology, v. 16, art. 1711557, 2025. DOI: https://doi.org/10.3389/fendo.2025.1711557.
FIRWANA, M. et al. A systematic review supporting the Endocrine Society clinical practice guidelines on central precocious puberty. The Journal of Clinical Endocrinology & Metabolism, v. 111, n. 8, p. 2145-2153, 2026. DOI: https://doi.org/10.1210/clinem/dgag169.
HERAS, V. et al. Central ceramide signaling mediates obesity-induced precocious puberty. Cell Metabolism, v. 32, n. 6, p. 951-966.e8, 2020. DOI: https://doi.org/10.1016/j.cmet.2020.10.001.
HUANG, J. S. et al. Association of childhood obesity with pubertal development in boys: a systematic review and meta-analysis. Obesity Reviews, v. 26, n. 3, art. e13869, 2025. DOI: https://doi.org/10.1111/obr.13869.
JIN, C.; ZHAO, G. Creatine acts as a mediator of the causal effect of obesity on puberty onset in girls: evidence from mediation Mendelian randomization study. Metabolites, v. 14, n. 3, art. 137, 2024. DOI: https://doi.org/10.3390/metabo14030137.
KIM, S. J. et al. 2022 clinical practice guidelines for central precocious puberty of Korean children and adolescents. Annals of Pediatric Endocrinology & Metabolism, v. 28, n. 3, p. 168-177, 2023. DOI: https://doi.org/10.6065/apem.2346168.084.
LAM, B. Y. H. et al. MC3R links nutritional state to childhood growth and the timing of puberty. Nature, v. 599, n. 7885, p. 436-441, 2021. DOI: https://doi.org/10.1038/s41586-021-04088-9.
LATRONICO, A. C. et al. Central precocious puberty: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, v. 111, n. 8, p. 2101-2144, 2026. DOI: https://doi.org/10.1210/clinem/dgag168.
LI, Y. et al. Adiposity status, trajectories, and earlier puberty onset: results from a longitudinal cohort study. The Journal of Clinical Endocrinology & Metabolism, v. 107, n. 9, p. 2462-2472, 2022. DOI: https://doi.org/10.1210/clinem/dgac395.
MANCINI, A. et al. Evaluation of kisspeptin levels in prepubertal obese and overweight children: sexual dimorphism and modulation of antioxidant levels. European Review for Medical and Pharmacological Sciences, v. 25, n. 2, p. 941-949, 2021. DOI: https://doi.org/10.26355/eurrev_202101_24663.
MANFREDI-LOZANO, M. et al. Defining a novel leptin-melanocortin-kisspeptin pathway involved in the metabolic control of puberty. Molecular Metabolism, v. 5, n. 10, p. 844-857, 2016. DOI: https://doi.org/10.1016/j.molmet.2016.08.003.
NIEUWENHUIS, D. et al. Adipokines: a gear shift in puberty. Obesity Reviews, v. 21, n. 6, art. e13005, 2020. DOI: https://doi.org/10.1111/obr.13005.
NOKOFF, N. et al. Sex differences in effects of obesity on reproductive hormones and glucose metabolism in early puberty. The Journal of Clinical Endocrinology & Metabolism, v. 104, n. 10, p. 4390-4397, 2019. DOI: https://doi.org/10.1210/jc.2018-02747.
PEREIRA, A. et al. Association between markers of adiposity during childhood and puberty onset in Latino girls. The Journal of Clinical Endocrinology & Metabolism, v. 108, n. 11, p. e1272-e1281, 2023. DOI: https://doi.org/10.1210/clinem/dgad294.
ROA, J. et al. Metabolic regulation of female puberty via hypothalamic AMPK-kisspeptin signaling. Proceedings of the National Academy of Sciences of the United States of America, v. 115, n. 45, p. E10758-E10767, 2018. DOI: https://doi.org/10.1073/pnas.1802053115.
RODRIGUES-SANTOS, I. et al. Increase of astrocyte apposition on GnRH neurons in early puberty onset induced by high fat diet. Journal of Neuroendocrinology, v. 37, n. 8, art. e70029, 2025. DOI: https://doi.org/10.1111/jne.70029.
SAKORNYUTTHADEJ, N. et al. Long-term outcomes of gonadotropin-releasing hormone analogue therapy in central precocious puberty: a comparative analysis of obese and normal-weight girls. Clinical Endocrinology, v. 105, n. 5, p. 549-555, 2026. Publicação on-line: 30 jul. 2026. DOI: https://doi.org/10.1111/cen.70195.
SHALITIN, S.; GAT-YABLONSKI, G. Associations of obesity with linear growth and puberty. Hormone Research in Paediatrics, v. 95, n. 2, p. 120-136, 2022. DOI: https://doi.org/10.1159/000516171.
SHI, L.; JIANG, Z.; ZHANG, L. Childhood obesity and central precocious puberty. Frontiers in Endocrinology, v. 13, art. 1056871, 2022. DOI: https://doi.org/10.3389/fendo.2022.1056871.
TARIF, D. et al. Association of multiple indicators of pubertal timing with depressive symptoms and depression in adolescent girls. The British Journal of Psychiatry, v. 229, n. 3, p. 271-277, 2026. DOI: https://doi.org/10.1192/bjp.2025.88.
TENEDERO, C. B.; OEI, K.; PALMERT, M. R. An approach to the evaluation and management of the obese child with early puberty. Journal of the Endocrine Society, v. 6, n. 1, art. bvab173, 2022. DOI: https://doi.org/10.1210/jendso/bvab173.
VAZQUEZ, M. J. et al. SIRT1 mediates obesity- and nutrient-dependent perturbation of pubertal timing by epigenetically controlling Kiss1 expression. Nature Communications, v. 9, n. 1, art. 4194, 2018. DOI: https://doi.org/10.1038/s41467-018-06459-9.
WANG, G. et al. Plasma insulin concentration in newborns and children and age at menarche. Diabetes Care, v. 46, n. 6, p. 1231-1238, 2023. DOI: https://doi.org/10.2337/dc22-2017.
WANG, L. et al. Causal relationships between birth weight, childhood obesity and age at menarche: a two-sample Mendelian randomization analysis. Clinical Endocrinology, v. 98, n. 2, p. 212-220, 2023. DOI: https://doi.org/10.1111/cen.14831.
ZEVIN, E. L.; EUGSTER, E. A. Central precocious puberty: a review of diagnosis, treatment, and outcomes. The Lancet Child & Adolescent Health, v. 7, n. 12, p. 886-896, 2023. DOI: https://doi.org/10.1016/S2352-4642(23)00237-7.
ZHOU, S. et al. Association between maternal body mass index, offspring growth and pubertal timing: results from a longitudinal birth cohort study. American Journal of Epidemiology, publicação antecipada on-line, identificador kwag128, 2026. DOI: https://doi.org/10.1093/aje/kwag128.
ZHOU, T.; XIONG, F. Association between childhood weight status and timing of puberty: a systematic review and meta-analysis. Translational Pediatrics, v. 15, n. 8, art. 315, 2026. DOI: https://doi.org/10.21037/tp-2026-0362.
ZHOU, X. et al. Overweight/obesity in childhood and the risk of early puberty: a systematic review and meta-analysis. Frontiers in Pediatrics, v. 10, art. 795596, 2022. DOI: https://doi.org/10.3389/fped.2022.795596.
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Copyright (c) 2026 Isla Kelly Alves de Andrade, Luis Felipe Bueno da Silva, Fabrício Augusto Rodrigues de Castro, Carlos Humberto de Sousa Neto , Letícia Tremocoldi Martinelli , Beatriz De Morais Utida, Maria Clara Castilho Rodrigues , Guilherme Lopes Rodrigues de Oliveira , Gabriel Silva de Paula, Luiza Mendonça de Novaes , Maria Izabel Beloti de Souza , Naysa Gabrielly Alves de Andrade
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Os autores são detentores dos direitos autorais mediante uma licença CCBY 4.0.
