Counsel a family on a new diagnosis of central precocious puberty — OSCE

Candidate instructions

You are the paediatric registrar in the endocrine clinic. You have eight minutes to counsel the parents of a 6-year-old girl whose progressive central precocious puberty has just been confirmed. Address what the diagnosis means, why a brain MRI is needed, what the GnRH-analog treatment does and does not do, what the prognosis is, and how the decision to treat is shared. Use plain language, check understanding, invite questions, and respond to their worry that 'just waiting' might be safer. [1] [2]

The encounter and the marking domains

Information sharing — what the diagnosis means. I explain that their daughter's body has switched on the normal puberty pathway a few years early — the same hormones, the same sequence, just started sooner — and that the growth spurt and bone-age advance show it is active and progressive. I name it central precocious puberty, and I explain that 'central' means the brain's normal control centre is driving it. I avoid jargon and check their understanding before moving on. [1]

Why a brain MRI is needed. I explain that because she is under 6 years we image the brain to look for a small, benign birth difference called a hypothalamic hamartoma, or very rarely a tumour, that can switch puberty on early; in most girls this age the scan is normal and the cause is simply idiopathic, but we look to be safe. I acknowledge that the word 'tumour' is frightening and that the scan is precautionary. [1] [2]

What the GnRH analog does and does not do. I explain that the treatment — a monthly or three-monthly injection, or a yearly implant — gently switches the early puberty back off, so the bone age stops racing ahead and her adult height is protected. I am explicit about what it does not do: it does not change who she is, it does not affect her future fertility, and it is fully reversible — when we stop it, puberty resumes normally. I address their fear of injections and offer the longer-acting options. [3]

Why 'wait and see' carries a cost. I acknowledge that watching feels safer, but I explain the specific risk: the longer the sex steroids run, the faster the bone age advances and the earlier the growth plates fuse, so the tall child now risks being the short adult — and that window to protect her height is the reason we act now rather than later. I frame treatment as protecting a height opportunity that closes, not as an emergency. [1] [3]

Shared decision and prognosis. I invite their questions, summarise the plan — GnRH analog, monitoring of growth and bone age every three to six months, psychological support, and a defined stopping point when further height gain is negligible — and I affirm the prognosis: treated, her adult height and fertility are expected to be normal, and puberty will resume in step with her peers. I close by checking their understanding and their decision. [2] [3]