Case Report: A 7 years 5-month-old female presented in our clinic for evaluation of early pubertal development. Parents reported telarche occurring at age 6 years and menarche at age 7 years and 3 months. No history of development of pubic or axillary hair, adult body odor, or acne. Mother had menarche at 13 years of age. Physical examination revealed a height of 138 cm (>95th centile). Mid-parental height was calculated at 157 cm (20th centile). She was found to be Tanner 3 for breasts and Tanner 1 for pubic hair. Rest of examination was unremarkable. A leuprolide stimulation test confirmed a diagnosis of central precocious puberty, with a peak LH of 37 IU/l and a stimulated estradiol of 118 pg/ml. Bone age was read at 12 years of age at a chronological age of 7 years and 5 months. CT and MRI of the brain revealed a duplication of the sella turcica and two sets of pituitary glands each with its own pituitary stalk and two posterior pituitary bright spots. Started on leuprolide acetate, (Lupron Depot) 300 μgc/kg per monthly. She had good suppression chemically and clinically of pubertal progression. Eight months after starting leuprolide therapy, at a chronological age of 8 years and 3 months, her bone age was read at 13 years and 6 months. Parents decided to stop treatment after 10 months, against medical advice, due to pain during injections. Her last height was 144.6 cm with a bone age of 13 years and 6 months.
Discussion: Duplication of the pituitary gland is a rare finding that results from an earlier developmental anomaly. It can be associated with central precocious puberty or delayed puberty, as well as other facial and CNS abnormalities.
18 Sep 2014 - 20 Sep 2014