Other growth and puberty problems

Question 1

Premature adrenarche

Answer 1

This is the isolated appearance of pubic hair

• usually in a girl
• <6–9 years
• without other features of virulisation

It is usually a normal variant but watch for congenital adrenal hyperplasia.

Question 2

Premature thelarche

Answer 2

This is isolated breast development in girls <8 yrs without other pubertal signs.

It is benign and observe with reassurance.

Question 3

Pubertal breast hyperplasia

Answer 3

This is a normal variant of puberty.

It is common in normal adolescent males and is transient.

There is no hormonal, medical or surgical treatment.

Question 4

Features of Growing pains (benign nocturnal limb pain)

Answer 4

Typical age 3–12 yrs

Positive family history

Pain wakes child

Poorly localised in leg—knee, shin, calf

Usually lasts 20–30 mins, (maybe hours) regardless of Rx

Normal examination

No pain or disability next morning

Question 5

Management of Growing pains (benign nocturnal limb pain)

Answer 5

Reassurance

Resolves spont. in time

Consider heat pack and simple analgesics

Massage is helpful

Check ESR if in doubt