Abstract
Incomplete or isolated precocious puberty is defined as partial sexual development that is transient and occurring in the absence of other stigmata of puberty. It encompasses isolated breast development (premature thelarche), isolated pubic hair appearance (premature adrenarche or pubarche), and isolated uterine bleeding (premature menarche). Isolated pubertal signs may be seen in prepubertal girls 1–4 % of the time. The major underlying theme in the setting of isolated pubertal signs includes an absence of increased linear growth or advanced skeletal maturation. In addition, baseline hormonal values are typically within the normal range for age and sexual development. There may be slow progression, stabilization, or waning over the course of time following the diagnosis of isolated precocious puberty. It is important to recognize the condition and follow up at appropriate intervals as approximately 20–30 % of cases may progress to central precocity. Nonetheless, 2/3 of patients will not progress and eventually experience puberty and growth at the normal expected time without sequelae.
Keywords
Isolated premature thelarche Isolated premature pubarche Isolated premature menarcheReferences
- 1.Pasquino AM, Piccolo F, Scalamandre A, Malvaso M, Ortolani R, Boscherini B. Hypothalamo-pituitary-gonadotropin function in girls with premature thelarche. Arch Dis Child. 1980;55:941–4.PubMedCentralPubMedCrossRefGoogle Scholar
- 2.Stanhope R, Brook CH. Thelarche variant: a new syndrome of precocious sexual maturation. Acta Endocrinol (Copenh). 1990;123:481–6.PubMedGoogle Scholar
- 3.Pasquino AM, Tebaldi L, Cioschi L, et al. Premature thelarche: a follow up study of 40 girls. Arch Dis Child. 1985;60:1180–92.PubMedCentralPubMedCrossRefGoogle Scholar
- 4.Mills JL, Stolley PD, Davies J, et al. Premature thelarche: natural history and etiologic investigation. Am J Dis Child. 1981;135:743.PubMedCrossRefGoogle Scholar
- 5.Pasquino AM, Pucarelli I, Passeri F, et al. Progression of premature thelarche to central precocious puberty. J Pediatr. 1995;126:11.PubMedCrossRefGoogle Scholar
- 6.Verrotti A, Ferrari M, Morgese G, et al. Premature thelarche: a long-term follow-up. Gynecol Endrocrinol. 1996;10:241.CrossRefGoogle Scholar
- 7.Zhu SY, Du ML, Huang TT. An analysis of predictive factors for the conversion from premature thelarche into complete central precocious puberty. J Pediatr Endocrinol Metab. 2008;21:533.PubMedGoogle Scholar
- 8.Uçar A, Saka N, Baş F, Bundak R, Günöz H, Darendeliler F. Is premature thelarche in the first two years of life transient? J Clin Res Pediatr Endocrinol. 2012;4(3):140–5.PubMedCentralPubMedCrossRefGoogle Scholar
- 9.Haber HP, Wollmann HA, Ranke MB. Pelvic ultrasonography: early differentiation between isolated premature thelarche and central precocious puberty. Eur J Pediatr. 1995;154(3):182–6.PubMedCrossRefGoogle Scholar
- 10.Volta C, Bernasconi S, Cisternino M, Buzi F, Ferzetti A, Street ME, Da Milano AM. Isolated premature thelarche and thelarche variant: clinical and auxological follow-up of 119 girls. J Endocrinol Invest. 1998;21(3):180–3.PubMedCrossRefGoogle Scholar
- 11.Tenore A, Franzese A, Quattrin T, Sandomenico ML, Aloi G, Gallo P, Mariano A, Di Maio S. Prognostic signs in the evolution of premature thelarche by discriminant analysis. J Endocrinol Invest. 1991;14:375–81.PubMedCrossRefGoogle Scholar
- 12.de Lange AH, Bocca G. Vaginal bleeding in a 4-month-old preterm girl: extreme minipuberty mimicking central precocious puberty. J Pediatr Endocrinol Metab. 2013;26(5–6):595–7.PubMedGoogle Scholar
- 13.Neely EK, Wilson DM, Lee PA, Stene M, Hintz RL. Spontaneous serum gonadotropin concentrations in the evaluation of precocious puberty. J Pediatr. 1995;127:47–52.PubMedCrossRefGoogle Scholar
- 14.Diaz A, Bhandari S, Sison C, Vogiatzi M. Characteristics of children with premature pubarche in the New York metropolitan area. Horm Res. 2008;70(3):150–4.PubMedCrossRefGoogle Scholar
- 15.Slyper AH. The pubertal timing controversy in the USA, and a review of possible causative factors for the advance in timing of onset of puberty. Clin Endocrinol (Oxf). 2006;65(1):1–8.CrossRefGoogle Scholar
- 16.Silverman SH, Migeon C, Rosemberg E, Wilkins L. Precocious growth of sexual hair without other secondary sexual development; premature pubarche, a constitutional variation of adolescence. Pediatrics. 1952;10:426–32.PubMedGoogle Scholar
- 17.Ibanez L, Virdis R, Potau N, et al. Natural history of premature pubarche: an auxological study. J Clin Endocrinol Metabol. 1992;74:254–7.Google Scholar
- 18.Kousta E. Premature adrenarche leads to polycystic ovary syndrome? Long-term consequences. Ann N Y Acad Sci. 2006;1092:148–57.PubMedCrossRefGoogle Scholar
- 19.Ibanez L, et al. Hyperinsulinemia and decreased insulin-like growth factor binding protein-1 are common features in prepubertal and postpubertal girls with a history of premature pubarche. J Clin Endocrinol Metab. 1997;82:2283–8.PubMedGoogle Scholar
- 20.Moghetti P, Castello R, Negri C, et al. Insulin infusion amplifies 17 alpha hydroxycorticosteroid intermediates response to adrenocorticotropin in hyperandrogenic women: apparent relative impairment of 17,20-lyase activity. J Clin Endocrinol Metab. 1996;81:881–6.PubMedGoogle Scholar
- 21.Williams RM, Ward CE, Hughes IA. Premature adrenarche. Arch Dis Child. 2012;97(3):250–4.PubMedCrossRefGoogle Scholar
- 22.Ibáñez L, Valls C, Marcos MV, Ong K, Dunger DB, de Zegher F. Insulin sensitization for girls with precocious pubarche and with risk for polycystic ovary syndrome: effects of prepubertal initiation and postpubertal discontinuation of metformin. J Clin Endocrinol Metab. 2004;89:4331–7.PubMedCrossRefGoogle Scholar
- 23.Ibáñez L, López-Bermejo A, Díaz M, Marcos MV, de Zegher F. Early metformin therapy (age 8–12 years) in girls with precocious pubarche to reduce hirsutism, androgen excess, and oligomenorrhea in adolescence. J Clin Endocrinol Metab. 2011;96(8):E1262–7.PubMedCrossRefGoogle Scholar
- 24.Murran D, Dewhurst J, Grant DB. Premature menarche: a follow-up study. Arch Dis Childhood. 1983;58:142–3.CrossRefGoogle Scholar
- 25.Heller ME, Dewhurst J, Grant DB. Premature menarche without the evidence of precocious puberty. Arch Dis Childhood. 1979;54:472–5.CrossRefGoogle Scholar
- 26.Traggiai C, Stanhope R. Disorders of pubertal development. Best Pract Res Clin Obstet Gynaecol. 2003;17(1):41–56.PubMedCrossRefGoogle Scholar
- 27.Trivers KF, Gammon MD, Abrahamson PE, Lund MJ, Flagg EW, Kaufman JS, et al. Association between reproductive factors and breast cancer survival in younger women. Breast Cancer Res Treat. 2007;103:93–102.PubMedCrossRefGoogle Scholar
- 28.Lakshman R, Forouhi NG, Sharp SJ, Luben R, Bingham SA, Khaw KT, et al. Early age at menarche associated with cardiovascular disease and mortality. J Clin Endocrinol Metab. 2009;94:4953–60.PubMedCrossRefGoogle Scholar
- 29.He C, Zhang C, Hunter DJ, Hankinson SE, Buck GM, Louis GM, Hediger ML, et al. Age at menarche and risk of type 2 diabetes: results from 2 large prospective cohort studies. Am J Epidemiol. 2010;171:334–44.PubMedCentralPubMedCrossRefGoogle Scholar
- 30.Ibáñez L, Lopez-Bermejo A, Diaz M, Marcos MV, de Zegher F. Early metformin therapy to delay menarche and augment height in girls with precocious pubarche. Fertil Steril. 2011;95(2):727–30.PubMedCrossRefGoogle Scholar