Early puberty: a cautionary tale.

Abstract

To the Editor. Drs Pathomvanich, Merke, and Chrousos have presented their experience with an instructive patient—a white girl whose pubic hair growth began shortly after her sixth birthday and breast development approximately a year and a half later. An evaluation did not occur until she was age 8.5, when significant insulin resistance was found. The authors go on to state that the child “fell within the normal range according to the data presented by Herman-Giddens et al.”1 We disagree. At least 3 factors about this girl's findings should have alerted her pediatrician to the need for an endocrine referral. First, the age at which her pubic hair growth began was 2.5 standards deviations (SDs) below the mean according to the data presented in our study. Second, it is less common for white girls to begin pubic hair growth before breast development. Third, the long delay between the onset of pubic hair growth and breast growth (greater than a year) is not typical of the normal pubertal sequence of growth. To summarize, this child exhibited premature breast development (not falling into the normal …