Abstract
9-year, 3-month-old girl is referred for concerns about early puberty. Her mother reports progressive breast development for at least a year, along with adult body odor requiring deodorant use for the past 6 months. The mother does not report any body hair, vaginal discharge, or bleeding, but states that her daughter has been rapidly outgrowing shoes and clothing. There is no history of exogenous hormone exposure, and the child has been otherwise healthy. The child’s medical history reveals that she was born at term with a birth weight of 7 lb, 5 oz and a length of 20 00 . According to the family history, the child’s mother is 5 0 3 00 and experienced menarche at age 12 years, and the father is 5 0 7 00 and was at an average age at the onset of puberty. The child is an honor roll student in the fourth grade and lives at home with her parents and 6-year-old brother. Review of systems reveals increased “moodiness” and is otherwise noncontributory. Physical examination reveals a height of 140 cm (86th percentile) and weight of 44 kg (97th percentile). Body mass index is 22.4 kg/m 2 (96th percentile; z-score, 1.75). Head, eyes,ears,nose,andthroatexamination revealsa normal thyroid to palpation. Breasts are Tanner stage III-IV, and no axillary hair is noted. Genitourinary examination reveals a normal female with pubic hair Tanner stage II and an estrogenized vaginal mucosa. Bone age radiography is advanced at 12 years, giving the child a predicted adult height
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