Signs Of Precocious Puberty Research Articles

A Case of Precocious Pseudopuberty Associated With Ovarian Follicular Cyst

AbstractA case of precocious pseudopuberty associated with a follicular cyst in the ovary is described. A five‐year‐and‐month‐old Japanese girl had breast enlargement, areolar pigmentation and intermittent genital bleeding. On laparotomy, bilateral ovarian cysts were found. The left cyst (4.0 times 4.0 times 3.5 cm) was far larger than the right (1.5 times 1.3 times 1.3). The fluid in the left cyst contained a high concentration of estrogens. Therefore, the main cause of the precocious puberty was thought to be the left cyst. It was clearly detected by ultrasonography and computed tomography only when the signs of precocious puberty were remarkable and the serum estrogen level was increased; however, the right one could not be detected throughout the observation. We consider that in the case of intermittent puberty a functioning ovarian cyst can be identified more easily when the signs of precocious puberty are remarkable and the serum estrogen level is increased.

Ultrasound evaluation of female isosexual precocious puberty.

Fifty-six female children with signs of precocious puberty were examined. Adult-sized ovaries and an intermediate-sized uterus were characteristic of true sexual precocity, either idiopathic or due to a CNS lesion. Premature thelarche and premature adrenarche showed normal infantile pelvic organs, while in cases of precocious pseudopuberty, the appearances of the ovaries and uterus varied depending upon the underlying process. Large ovarian cysts and large ovaries were found in six patients with McCune-Albright syndrome. An ultrasound study is of benefit in the evaluation of female children with precocious sexual development because it can demonstrate the adult-sized ovaries of true precocious puberty, thereby distinguishing this condition from premature thelarche and premature adrenarche, and it can demonstrate specific causes of precocious sexual development, such as adrenal and ovarian tumors and ovarian cysts.

Pulsatile secretion of luteinizing hormone and sleep-related gonadotropin rhythms in girls with premature thelarche.

The concentrations of LH, FSH and PRL were determined in serum samples obtained at night in 1-2 h intervals as well as at 15 min intervals during a 3 h period between 9 and 12 p.m. and 9 and 12 a.m. in three girls with premature thelarche, who had not developed further signs of precocious puberty for more than 18 months. A sleep-dependent LH and FSH increase was documented in all of them with a predominance of FSH secretion during sleep and after LHRH stimulation. In all three girls an episodic pattern of LH was found during sleep. In daytime minor fluctuations of LH secretion were found in two patients whereas in one patient an episodic LH pattern was demonstrable with minor peak values as during sleep. Normal PRL secretion during sleep as well as after TRH stimulation excludes a permissive role of this hormone in premature thelarche. We conclude that in girls with isolated premature thelarche a matured hypothalamo-pituitary gonadotropin axis is active comparable to normal pubertal children.

Treatment of Cryptorchidism with Pernasal Gonadotropin-Releasing Hormone Therapy

Twenty-five boys between 1 and 10 years of age with unilateral or bilateral cryptorchidism were treated with 200 microgram of gonadotropin-releasing hormone (GnRH) pernasally six times daily until descensus was completed, or for 10 weeks at most. Complete descent of the tests occurred in 16 patients, usually after 2 to 5 weeks of treatment. No adverse side effects have been observed. Radioimmunologic measurements of serum luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, and prolactin, carried out before treatment, at the end of treatment, and 6 months after treatment, showed a transitory increase of the LH responsiveness to GnRH in only four of the patients and in the group as a whole a slight but significant decrease of FSH responsiveness. There were no signs of precocious puberty. GnRH antibodies were not found.

Precocious puberty resulting from interstitial cell hyperplasia

A 2½ year old boy presented with excessive growth and other signs of precocious puberty. The left testis was slightly larger than the right, but both were of pre-pubertal size (1 - 2 mls). Investigation showed a high serum testosterone. Ihe relative value of different techniques (tomography, angiography, iodocholestsrol scanning, and venous sampling) in localising the site of the excessive testosterone production are compared. Eventually the left testis was removed and histological examination revealed generalised interstitial cell hyperplasia without actual tumour formation.

TREATMENT OF PRECOCIOUS PUBERTY WITH CYPROTERONE ACETATE

Extract: Cyproterone acetate, an antiandrogenic steroid with inhibitory effects on gonadotropin secretion, was given to 13 girls and 6 boys with precocious puberty for periods of 1–3 years in a daily dose of 70 mg/m2 body surface area. Treatment was started at a mean chronologic age of 6.65 years in girls and 6.21 years in boys. No side effects were noted and the compound had a beneficial effect on the clinical signs of precocious puberty with the exception of increased growth velocity. Testicular size remained unchanged during treatment. In one boy high testosterone concentration in plasma was reduced to prepubertal levels. For analysis of the effect of treatment on growth the standard deviation score method was used. The data for height, bone age, height for bone age, and height prediction were compared with those obtained from 21 girls and 11 boys with precocious puberty who did not receive cyproterone acetate. No significant differences between treatment and control groups were found. It is concluded that cyproterone acetate in the dosage used is without effect on growth and would therefore be expected not to prevent short adult stature in patients with precocious puberty. Speculation: From the present study it is evident that cyproterone acetate at the dosage used does not diminish the rate of skeletal maturation, but that with other respects it is effective through its antiandrogenic and gonadotropin-inhibiting properties. This may indicate that in precocious puberty, bone maturation is more sensitive to the action of androgens and less suppressible than the secondary sex characteristics or behavioral changes. Whether earlier treatment and/or higher doses would also inhibit bone maturation remains uncertain.

BILATERAL NON FUNCTIONNING THECOMA OF THE OVARY IN EPILEPTIC CHILDREN UNDER ANTICONVULSANT THERAPY

SummaryThe peculiar features of two bilateral thecoma of the ovary are described. They were discovered because of a rapid enlargement of the abdomen with hemorrhagic ascites, but without any sign of precocious puberty. They occurred in young females treated with anti‐convulsant therapy for epilepsy. They have been cured with surgery alone.A third case has been found in the literature. Discussion is raised about the meaning of this association. The possible relationship with side‐effect of anti‐epileptic drugs is suggested.