Which of the following are true about precocious puberty? (Select all that apply, some, one, or none)

A. May be idiopathic: In many cases, especially central precocious puberty, no identifiable underlying cause is found. This is referred to as idiopathic precocious puberty and is a common diagnosis, particularly in girls.

B. Peripheral precocious puberty is independent of gonadotropin release from the pituitary gland: Peripheral (or gonadotropin-independent) precocious puberty occurs due to hormone secretion from sources other than the pituitary, such as adrenal tumors or ovarian cysts.

C. Central precocious puberty is caused by premature activation of the hypothalamic-pituitary-gonadal (HPG) axis: This is the most common form and involves early activation of the normal puberty pathway via the HPG axis.

D. It is defined as the onset of secondary sexual characteristics before age 8 in girls and age 9 in boys: This is the widely accepted medical definition of precocious puberty based on chronological age for the appearance of secondary sexual characteristics.

E. Tall stature during childhood is a common feature, but final adult height may be shorter than expected without treatment: Early growth spurts can lead to early closure of growth plates, resulting in reduced adult height if untreated.

A. Blood glucose levels in DKA are typically higher than in HHS: In fact, HHS usually presents with higher blood glucose levels than DKA—often exceeding 600 mg/dL, while DKA typically ranges from 250 to 600 mg/dL.

B. DKA involves significant ketosis and metabolic acidosis, while HHS typically does not: DKA is characterized by the breakdown of fats into ketones, leading to metabolic acidosis. HHS typically lacks significant ketosis because insulin levels, while low, are still sufficient to suppress ketogenesis.

C. DKA is more common in type 1 diabetes, while HHS is more common in type 2 diabetes: DKA usually occurs in individuals with type 1 diabetes due to absolute insulin deficiency. HHS is more often seen in type 2 diabetics who still produce some insulin but not enough to prevent severe hyperglycemia and dehydration.

D. None of the above: This choice is incorrect, as B, C, and E are valid differences between DKA and HHS.

E. HHS patients often have more severe dehydration than DKA patients: HHS leads to profound osmotic diuresis over a longer period, causing extreme dehydration. DKA progresses faster but with less total fluid loss compared to HHS.