Precocious puberty is caused by a heterogeneous group of disorders, which range from idiopathic to malignant tumours. The radiologist's role is to help: (1) differentiate precocious puberty from pubertal variants; (2) identify the underlying cause of precocity if present; and (3) assess for effectiveness of treatment. This pictorial review discusses the types of precocious puberty and their underlying aetiologies, differentiates precocious puberty from pubertal variants and illustrates the appropriate imaging evaluation for the patient diagnosed with precocious puberty.