When a Natural Process Happens Too Soon

Puberty is a normal part of growing up. For some children, puberty may start at too early of an age. When this happens, it may be due to a condition called central precocious puberty (CPP). CPP occurs when a child shows signs of puberty sooner than normal—before the age of 8 in girls and before the age of 9 in boys.1,2 CPP is a rare condition that affects 1 in every 5,000 to 10,000 children.3

If you suspect your child has CPP, it’s probably because you’ve noticed changes in your child’s physical development that seem to be happening sooner than they should. This might leave you feeling confused, concerned, or stressed. It’s important to know that there is power in information. Explore this section to better understand the causes of CPP, the potential symptoms and effects, and available treatments.

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CPP Causes and Diagnosis

Although the exact cause is usually unknown, CPP results from the early release of a hormone from the brain called gonadotropin-releasing hormone (GnRH), which causes a child to begin puberty at an age earlier than normal.4,5

A pediatric endocrinologist is a type of physician who specializes in diagnosing, treating, and managing disorders involving hormones, including CPP. If CPP is suspected, your pediatric endocrinologist will evaluate your child, and may order further testing. Some of those tests could include:4

  • Blood tests to measure hormone levels, including a test called a GnRH stimulation test. In children with CPP, GnRH will cause other hormone levels in the body to rise. In children without CPP, these hormone levels will stay the same.
  • An x-ray of the hand and wrist to measure how fast your child's bones are growing (often called a bone age test or study).
  • An MRI (magnetic resonance imaging) or CT (computed tomography), which is a scan of the brain that looks to see whether any brain abnormalities are causing puberty to start too soon.

How Does CPP Affect Children?

The good news is that there is treatment for CPP. Below are some reasons why you and your child’s
physician may choose to move forward with treatment.

Growth and Height

Your child may have experienced a growth spurt related to CPP and may even be tall for his or her age. Treatments for CPP are designed to delay puberty by stopping the signaling of certain hormones that are responsible for jump-starting the puberty process.6

Children with CPP can be taller than their peers; however, children that go untreated may be shorter in height when they become adults.This is because their growth plates (growth plates are areas of cartilage at the ends of long bones) close too early.6 Typically, growth plates close toward the end stages of puberty.

Social and Emotional Impacts

Girls and boys who begin puberty before their peers may be extremely self-conscious about the changes occurring in their bodies. This may affect their self-esteem and may increase their risk of developing depression, eating disorders, or substance abuse, perhaps as a result of standing out before they’re ready for the extra attention.4,7-9

There are no data demonstrating outcomes of Triptodur on stature, social, or emotional health.

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How to Talk to Your Child About CPP

Children with CPP may have a hard time understanding the changes taking place in their bodies, such as the growth of pubic or underarm hair, the appearance of acne, or the development of body odor. Girls may be upset to see their breasts growing or to get their first period, while boys may be surprised by facial hair or a deepening voice.

It’s not unusual for children with CPP to feel confused or embarrassed by these changes. Because they tend to look older physically, they are often expected to behave more maturely, which can increase the pressure and expectations placed upon them.9 As a parent, you play a key role in shaping your child’s understanding of CPP and creating a nurturing environment where your child can feel loved and supported.

Guiding Your Child Through Treatment

Keeping track of your child's growth

When you bring your child in for their regular doctor visits during treatment, it is helpful to report to the doctor any changes you see in your child’s body such as height, growth of underarm and pubic hair, breast development, voice change, and oily skin and acne.

Aside from the classic pencil markings on the doorway, there are other fun, interactive ways to track your child’s body changes. Below are some ideas to make tracking your child’s body changes less clinical and more fun!

Art project

Create a giant ruler or use blank measuring tape to track body changes with your child. There’s plenty of room to create fun designs and drawings together!


Let your child go to the store and pick out some of their favorite accessories. These accessories can be anything such as tiaras, scarves, a superhero costume, etc. Do regular “photoshoots” with your child using the same accessories and clothing items to track how fast they are outgrowing the items. You’ll be able to track your child’s growth and have some great photos for your memories!

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Treatment Options for CPP10,11

Below are some different treatments for CPP. Your child’s doctor can help you find the
treatment option that best fits your child.

Treatment Options for Central Precocious Puberty1,2
Injections Per Year
Every Month
(4 weeks)
Thirteen Injections Per Year
Every 3 Months
(12 weeks)
Four Injections Per Year


Every 6 Months
(24 weeks)
Two Injections Per Year
Once Every 12 months
*Surgical procedure involving the use of anesthesia.
The method of anesthesia utilized (ie, local, conscious sedation, general)

is at the discretion of the healthcare provider.


INDICATION: TRIPTODUR is indicated for the treatment of pediatric patients 2 years of age and older with central precocious puberty (CPP).

Do not use TRIPTODUR in:

  • Those allergic to gonadotropin releasing hormone (GnRH), GnRH agonist medicines, or any ingredients in TRIPTODUR.
  • Children under 2 years of age.
  • Women who are or may become pregnant.



  1. Muir A. Precocious puberty. Pediatr Rev. 2006;27:373-381.
  2. Carel JC, Léger J. Clinical Practice. Precocious puberty. N Engl J Med. 2008;358(22):2366-2377.
  3. Partsch CJ, Sippell WG. Treatment of central precocious puberty. Best Pract Res Clin Endocrinol Metab. 2002;16:165-189.
  4. Precocious Puberty. Mayo Clinic website. http://www.mayoclinic.org/diseases-conditions/precocious-puberty/symptoms-causes/dxc-20266003 Accessed March 20, 2023.
  5. What causes normal puberty, precocious puberty, & delayed puberty? Eunice Kennedy Shriver National Institute of Child Health and Human Development website. https://www.nichd.nih.gov/health/topics/puberty/conditioninfo/Pages/causes.aspx Accessed March 20, 2023.
  6. Carel JC, Lahlou N, Roger M, Chaussain JL. Precocious puberty and statural growth. Hum Reprod Update. 2004;10:135-147.
  7. Mendle J, et al. Detrimental psychological outcomes associated with early pubertal timing in adolescent girls. Dev Rev. 2007;27(2):151-171.
  8. Johansson T & Ritzen EM. Very long-term follow-up of girls with early and late menarche. Endocr Dev. 2005;8:126-136.
  9. Helping your child cope with precocious puberty. WebMD website. Available at: https://www.webmd.com/parenting/features/helping-your-child-cope#3 Accessed March 20, 2023.
  10. Helping your child cope with precocious puberty. WebMD website. Available at: https://www.webmd.com/parenting/features/helping-your-child-cope#3 Accessed March 20, 2023.
  11. Triptodur [package insert]. Woburn, MA 01801: Azurity Pharmaceuticals, Inc.
  12. Carel JC, Eugster EA, Rogol A, et al. Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics. 2009;123(4):e752-e762.



TRIPTODUR is indicated for the treatment of pediatric patients 2 years of age and older with central precocious puberty (CPP).


Do not use TRIPTODUR in:

  • Those allergic to gonadotropin releasing hormone (GnRH), GnRH agonist medicines, or any ingredients in TRIPTODUR.
  • children under 2 years of age
  • women who are or may become pregnant

Tell your child’s healthcare provider if any of the above conditions apply to your child.

It is important to stick to the dosing schedule (one injection every 24 weeks) in order for the drug to work. Do not miss or delay a scheduled dose.

Some people taking gonadotropin releasing hormone (GnRH) agonists like TRIPTODUR have had new or worsened mental (psychiatric) problems. Mental (psychiatric) problems may include emotional symptoms such as crying, irritability, restlessness (impatience), anger, or acting aggressive. Call your child’s doctor right away if your child has any new or worsening emotional symptoms while taking TRIPTODUR.

Some people taking GnRH agonists like TRIPTODUR have had seizures. The risk of seizures may be higher in people who have a history of seizures, have a history of epilepsy, have a history of brain or brain vessel (cerebrovascular) problems or tumors, are taking a medicine that has been connected with seizures such as bupropion or selective serotonin reuptake inhibitors (SSRIs). Seizures have also happened in people who have not had any of these problems. Call your child’s doctor right away if your child has a seizure while taking TRIPTODUR.

Some people taking triptorelin, the active ingredient in TRIPTODUR, have had serious allergic reactions. Call your child’s doctor or get emergency medical help right away if your child gets any of the following symptoms of a serious allergic reaction: skin rashes, redness, or swelling, severe itching, hives, trouble breathing or swallowing, fast heartbeat, sweating, throat tightness, hoarseness, swelling of face, mouth, and tongue, dizziness or fainting.

The most common side effects of TRIPTODUR include injection site reactions, menstrual (vaginal) bleeding, hot flush, headache, cough, and infections (bronchitis, gastroenteritis, influenza, nasopharyngitis, otitis externa, pharyngitis, sinusitis, and upper respiratory tract infection). These are not all the possible side effects of TRIPTODUR. Tell your child’s healthcare provider if they have any side effect that bothers them or that does not go away.

In the first few weeks after your child receives their first TRIPTODUR injection or after additional injections, TRIPTODUR can cause a brief increase in some hormones. During this time you may notice more signs of puberty in your child, including vaginal bleeding. Call your child’s doctor if signs of puberty continue after 2 months of receiving TRIPTODUR.

Reports of pseudotumor cerebri (idiopathic intracranial hypertension) have been observed in pediatric patients receiving GnRH agonists, including triptorelin. Patients and caregivers should contact their healthcare provider if the patient develops any of following symptoms of pseudotumor cerebri, including headache, and vision issues such as blurred vision, double vision, loss of vision, pain behind the eye or pain with eye movement, ringing in the ears, dizziness, and nausea.

These are not all the possible side effects of TRIPTODUR. Call your doctor for medical advice about side effects.

To report SUSPECTED ADVERSE REACTIONS, contact Azurity Pharmaceuticals, Inc. at 1-800-461-7449, or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

The Important Safety Information does not include all the information needed to use TRIPTODUR safely and effectively. For additional safety information, please consult the full Prescribing Information for PDF Document: TRIPTODUR (File Size: 153 KB).

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