This study aims to: (1) examine the anthropometric measurements and hormonal values of girls aged 5-8 years presenting with pubertal signs; (2) compare the presenting features, anthropometric, and pubertal findings of treated and untreated patient groups; and (3) highlight the importance of these data in making treatment decisions. Methods A total of 406 girls diagnosed with CPP and followed up in the pediatric endocrinology unit between 2021-2023 were included in this single-center, retrospective observational study. Girls with a starting age of pubertal signs <=8 years and those who started idiopathic puberty without menarche were included. Cases of peripheral precocious puberty, patients with organic lesions detected on cranial magnetic resonance imaging, secondary precocious puberty caused by cerebral palsy or hydrocephalus, accompanying systemic diseases, history of medications potentially affecting the HPG axis, growth hormone deficiency, uncontrolled thyroid disease, or adrenal-gonadal pathology, any metabolic or genetic diseases that causes CPP were excluded from the study. The patients were divided into two groups by evaluating their clinical findings during a minimum 6-month follow-up period: RP-CPP group, also receiving gonadotropin releasing hormone agonist (GnRHa) treatment (n=154), and the SP-CPP group, not receiving GnRHa treatment (n=252). The criteria for CPP included the onset of secondary sexual characteristics before age 8, increased double wall thickness of the endometrium, a uterus long axis >35 mm on pelvic ultrasonography (USG), a basal Luteinizing Hormone (LH) value>0.2 mIU/L, and bone age (BA) equal to or greater than chronological age (CA). Inclusion criteria for the RP-CPP group included breast development progressing through stages within 6 months, rapidly advancing BA and growth rate exceeding that of healthy children. Patients not meeting these criteria were classified as SP-CPP .[3] Results The median age was 7.1 years (range 5-8 years). The median birth weight was 3100 grams (IQR 2750-3406), and 61 patients (15%) were classified as SGA. At the time of presentation, the median weight was 0.9 SDS, the median height was 0.8 SDS, and the median BMI was 0.96 SDS. Obesity was observed in 19.4% of the cases (n=79). Among the patients, 252 were classified as SP-CPP , and 154 as RP-CPP . There were no significant differences in demographic and anthropometric data between these two groups (Table 1). When the pubertal examinations at the initial presentation were evaluated, the median stage of thelarche was 2 (IQR 2-3), and the median stage of pubarche was 2 (IQR 1-2). The laboratory and radiological features showed that the LH, FSH, E2, and peak LH values in the SP-CPP group were 0.6 (IQR 0.4-0.9) mIU/L, 2 (IQR 1.2-3) mIU/L, 5 (IQR 5-14.9) pg/mL, and 4.1 (IQR 3.4-5.9) mIU/L, respectively. In the RP-CPP group, these values were 0.8 (IQR 0.5-2.2) mIU/L, 2.5 (IQR 1.6-4.6) mIU/L, 10 (IQR 5-23.8) pg/mL, and 5 (IQR 3.6-7.5) mIU/L, respectively. All hormone levels in the RP-CPP group were statistically significantly higher than those in the SP-CPP group (p<0.001, p<0.001, p=0.003, and p=0.002, respectively) (Table 2). Conclusion In this cohort, the bone age/chronological age ratio is a significant parameter for early detection of rapidly progressing precocious puberty cases. It is crucial to classify early puberty cases by evaluating clinical, laboratory, and radiological findings collectively and to make treatment decisions based on individual assessments.