Premature Thelarche/ Adrenarche/ Menarche

Question 1

What is premature thelarche?

Answer 1

Premature thelarche describes girls who develop a small amount of breast tissue (typically 1” or less across), typically before the age of 3 years. The breasts do not get larger and the girl does not have a growth spurt.

Question 2

What investigations may you do for thelarche?

Answer 2

History/ Exam
X ray of hand/ wrist to determine bone age
Growth charts

there are no other associated pubertal changes. Bone age, growth velocity, and biochemical testing are normal

Question 3

What is the management of premature thelarche?

Answer 3

Watch for progression

Normal puberty may follow

Question 4

What is premature adrenarche?

Answer 4

Androgen related puberty like changes before the age of 8 (F) or 9 (M)

It is benign and needs no treatment or investigations

it is essential to rule out exposure to androgen sources such as creams or gels, adrenal tumors, and late-onset CAH

Question 5

What is premature menarche?

Answer 5

Isolated premature menarche is defined as isolated or recurrent vaginal bleeding in a prepubertal female in the absence of appropriate secondary sexual characters or a known pathological cause

Question 6

What are the clinical characteristics of a patient with premature menarche?

Answer 6

they may present with either a single episode or few cycles (less than 3) of bleeding and have normal progression to puberty

recent studies have suggested no effect on adult height

sexual abuse, vaginal foreign body, and infections of the vulva and vagina need to be ruled out.