SEXUAL PRECOCITY CAUSED BY OVARIAN FOLLICULAR CYSTS: SPONTANEOUS REGRESSION AND RECURRENCE WITH PREPUBERTAL GONADOTROPIN LEVELS

Abstract

Although small follicular ovarian cysts are common in asymptomatic prepubertal girls, larger ones may be associated with sexual precocity which can regress after cyst removal. We report 1 patient with recurrent functional ovarian cysts and another who had a presumptive single episode of cyst formation that regressed spontaneously. Patient 1 developed breasts at 3 years and vaginal bleeding at 4-10/12. Plasma estradiol (E2) was 180 pg/ml and LRF response was prepubertal (LH 0.4-0.8 ng/ml LER-960). E2 levels fell within 6 weeks to <10 pg/ml and remained low until 5-3/12 when bleeding recurred with E2 796 pg/ml. A 4×3 en ovarian follicular cyst with partial luteinization was removed from the left ovary. Cyst fluid contained 70,300 pg/ml E2; 21,600 pg/ml E1-Post-op the LRF test remained prepubertal when E2 was <10 pg/ml. At 5-5/12 E2 was 500 pg/ml and vaginal bleeding recurred. Treatment was begun with medroxyprogesterone acetate; during 20 months of therapy E2 has gradually fallen to <10 pg/ml and gonadotropin response to LRF remains prepubertal (LH 0.7-1.8 ng/ml). Patient 2 presented at 3-11/12 with breast development and E2 279 pg/ml. E2 fell to <10 pg/ml within 1 month and remained low for 2 years. At 6 years (BA 7-10/12) E2 was 13 pg/ml and the LRF test was pubertal. In sum 1) Markedly elevated E2 levels can occur in functional ovarian cysts as well as tumors. 2) Sporadic ovarian cyst formation may underlie some instances of premature thelarche or arrested sexual precocity.