Title: A Two Year Old Girl with Precocious Puberty: The Youngest Ever Age of Presentation
Authors: Shuchi Jain, Shivi Jain, Madhu Jain
DOI: http://dx.doi.org/10.18535/jmscr/v3i9.60
Abstract
Introduction: Precocious means developing unusually early .Precocious puberty is onset of puberty before 8 year in girls and 9 year in boys.1 When it is because of premature activation of hypothalamic pituitary axis, it is called central or complete precocious puberty. If it results from ectopic gonadotropin secretion, it is called peripheral precocious puberty. We hereby present a two year old menstruating girl with precocious puberty as a rare presentation.
Case Presentation: A two year old baby girl was brought by her parents to Gynecology outpatient department with complaint of per vaginal bleeding. On examination, her pubic and axillary hair, and breast were developed with Tanner stage 2 and 4 respectively. Her routine blood investigations and hormone profile were normal except increased level of Dehydroepiandrosterone. X-ray of her distal radio-ulnar joint and MRI scan of her brain were normal. On ultrasonography, a mass was visible (5.5×5.4 cm) in left adrenal gland which was confirmed by CT scan (5.2×3.9cm).
Conclusion: Hereby, we report an extremely rare case of peripheral precocious puberty with Tanner Stage 4 breast development and pubic hair (Tanner Stage 2) in a menstruating two year old girl due to benign adrenal adenoma.
Key words: Precocious puberty, Pseudo-precocious puberty, Peripheral precocious puberty, Adrenal adenoma.
References
1. ‘Precocious puberty’ at Dorland's Medical Dictionary
2. Kaplowitz PB, Oberfield SE. Re-examination of the age limit for defining when puberty is precocious in girls in the United States: implications for evaluation and treatment. Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society. Pediatrics 1999; 104 (4):936-941.
3. Khandekar S, Desh RJ. Clinical and hormonal studies in precocious puberty. Ind J Pediatr 1990; 57: 411-419.
4. Grunback M M, Dennis M. Puberty: Ontogeny, Neuroendocrinology, Physiology, and Disorder. In:Wilson JD, Foster DW, editors. William’s textbook of Endocrinology.8th ed. Philadelphia.WB Saunders Company:1992. P. 1139-1222.
5. Norton JA, Le HN. Adrenal tumors. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer Principles and practice of oncology. Philadelphia: Lippincott Williams and Wilkins: 2001.p.1770-1787.
6. Luton JP, Kuhn JM, de Gennes JL, Paulian B, Mahoudeau J, Laudat MH, et al. Adrenal adenoma secreting exclusively estrogen in a woman during her reproductive period.11-yr follow up. Presse med 1984Jan 14; 13(1):23-26.