ESPE Abstracts

Purpose: Peripheral precocious puberty is a variant of puberty in which gender characters emerge independent of the hypothalamo-pituitary axis. It may occur with ovarian-testicular-adrenal pathologies, hCG-secreting tumors, Mc. Cune Albright Syndrome, or an endocrine disruptor that may be a source of exogenous estrogen. In premature menarche, which is the other variant of early puberty, prepubertal uterine bleeding is observed independently of other findings of pubertal development.

Case Presentation: A 7-year-10-month-old girl patient applied to our clinic with a complaint of vaginal bleeding in the form of spotting that occurred twice a month apart and lasted for a day. There was no remarkable feature in the personal and family medical history. The mother's age at menarche was 12. In her physical examination; her weight was 32.8 kg (sds: 1.41), her height 131.5cm (sds: 0.99) and prepubertal, there was no cafe-au-lait. The laboratory results for gonadotropin levels are as follows: LH: <0.15mlU/mL, FSH: 0.57mlU/mL, E2: 39.4pg/mL. The findings of the pelvic ultrasound were that the uterus size 32x8x20 mm, the endometrial wall thickness was 1.7 mm, the right ovary measures 1.4 cc, and the left ovary measures 1.3 cc. Follicular cysts measuring in millimeters were detected in both ovaries. Upon questioning about dietary supplements, it was found that the patient, who was being evaluated for peripheral precocious puberty, had been regularly taking cranberry extract 800 mg (24.4 mg/kg/day) for protection of urinary tract infections for the past 2 years. The cranberry extract was discontinued, and there were no recurrent bleeding complaints.

Conclusion: Although estrogen and androgen receptors are expressed from early childhood, endogenous sex steroids are present at low levels during prepubertal periods. Therefore, it is known that this period is particularly sensitive to phytoestrogens, which are known to be rich in lignans and flavonoids. Cranberry extracts are used for the suppression of menopausal symptoms and prevention of recurrent urinary tract infections due to their phytoestrogenic effects. However, prolonged use of these phytoestrogens may lead to precocious puberty.