Background: The causes of most cases in girls with central precocious puberty is idiopathic, and tend to be older compared with neurogenic causes. When confronted with a very young child with sexual precosity, full endocrine work up is necessary and there is no doubt for the need to treat.
Case: SG presented at the age of 2.6 years with thelarche and pubarche for one month. As her mother is tall (175cm, 97th centile), she was concerned that her child had grown more rapidly in the last 7 months. The was no significant family history. Birth weight was 2.745 kg following elective caesarian section at 38 weeks gestation for pre-eclampsia. Growth tracked along the 25th centile for weight in the first year, and 91st centile for height. On examination, she was in A1 B2 P2. Treatment with GnRH analogue as Triptorelin was started within days of her blood test results. She tolerated her induction treatment with close monitoring of height velocity clinical symptoms. Decapeptyl was administered at short intervals of 8 weekly due to a detectable LH. She appeared happier with less temper tantrums and has stayed at B2.
|Time 0||Time 20 min||Time 60 min|
|17B oestradiol (pmol/L)||<73|
Prolactin 156 mU/L (0-566) TSH 1.63 mU/L (0.3-5.6) 17OHP 2 nmol/L androstenedione 1.9 nmol/L DHEA-S 0.5 umol/L testosterone <0.35 nmol/L IGF1 36.5 nmol/L (2.1 - 23.1). Tumour markers (bHCG, AFP) were negative. Urine steroid profile normal. Karyotype 46 XX.
LH 0.8 U/L FSH 1.8 U/L
LHRH stimulation test at 8th week - LH peak 1.83 U/L, FSH 1.76 U/L, 17B oestradiol < 73 pmol/L.
Imaging: Bone age 6 yrs 10 mths (CA 2.6 yrs). Pituitary MRI normal. Pelvic ultrasound - tiny ovarian follicles bilateral (0.6, 0.7 ml volumes), uterus 36x12x21 mm, 1.2mm endometrium. BA 7 yrs 10 mths (CA 5.6 yrs), 10 yrs (CA 7 yrs).
|Height cm (Ht SDS)||104.7 (+3.84)||109.9 (+3.7)||119.8(+3.34)||126.4(+3.13)||131.3 (+2.94)||134.4 (+2.92)|
|Weight kg (BMI SDS)||17.6 (-0.04)||19.3 (+0.07)||21.7 (-0.28)||24.5 (-0.07)||26.2 (-0.21)||29.1 (+0.27)|
Conclusion: Growth remains rapid in this child with a tall mother. It is unusual to see a case so young with no neurogenic cause for her central precocious puberty.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology