Growth disorder: Premature thelarche/adrenarche/menarche Flashcards
Define premature thelarche/adrenarche/menarche.
Early partial sexual development, often characterised by transient and minimal pubertal development in the absence of other stigmata of puberty.
Define premature thelarche.
Isolated development of the breasts in infancy,
Define premature adrenarche.
Pubic hair development before 8 years in females and 9 years in males.
Define isolated premature menarche.
Premature vaginal bleeding.
Explain the aetiology/risk factors for premature thelarche.
Due to period of relatively high but decreasing activity of the hypothalamic– pituitary–ovarian axis from age 6 months to 2 years.
Explain the aetiology/risk factors for premature adrenarche.
Caused by early maturation of the normal pubertal adrenal androgen secretory mechanism.
Explain the aetiology/risk factors for isolated premature menarche.
Spontaneous regression of an ovarian cyst, hypothyroidism, McCune– Albright syndrome; characterised by pigmented lesions similar to café-au-lait spots, polyostotic fibrous dysplasia and several endocrine disorders including toxicmultinodular goitre, amenorrhoea-galactorrhoea and precocious puberty.
Summarise the epidemiology of premature thelarche.
Relatively common in girls <2 years of age.
Summarise the epidemiology of premature adrenarche.
More common in Asian and Afro-Caribbean children.
Summarise the epidemiology of isolated premature menarche.
Uncommon.
What are signs and symptoms of premature thelarche?
Unilateral or bilateral enlargement of the breasts may occur physiologically between the ages of 6 months and 2 years. It is non-progressive and not associated with areolar development.
What are signs and symptoms of premature adrenarche?
: Pubic hair development is usually self-limiting. It may be associated with a slight “ in growth rate.
What are signs and symptoms of isolated premature menarche?
May occur physiologically in the postnatal period. Must be distinguished from bloody foul-smelling discharge (trauma, foreign body, sexual abuse) and bleeding from the urinary tract. Obtain detailed history and examination to determine other causes.
What are some appropriate investigations for premature thelarche/adrenarche/menarche?
General: May not be necessary with premature thelarche.
Pathology: LH/FSH/oestrogen levels, GnRH testing, ACTH testing (defects in steroidogenesis).
Radiology: USS of ovaries and uterus, bone age radiography.
Culture: Urine, vaginal discharge (premature menarche).
What is the management for premature thelarche/adrenarch/menarche?
Referral to specialist paediatric endocrinologist.
