Advances in the treatment of precocious puberty.
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A 6-month-old girl was referred with breast and pubic hair development. Investigations excluded an adrenal or central cause for her precocity. Ovarian ultrasound scans showed bilaterally enlarged ovaries with both solid and cystic changes. A follow-up examination suggested progression of the precocity and in view of the young age of the child, and concerns regarding underlying malignancy, she underwent laparotomy. Histology showed no evidence of neoplasia but there was stromal oedema consistent with a diagnosis of massive ovarian oedema. This entity is poorly recognised in the paediatric literature as a cause of sexual precocity, and has never previously been described in such a young patient. This is an unusual cause of precocity in a young child and its recognition and management are reviewed.
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The child with premature sexual development requires a thorough history, physical, and appropriate laboratory evaluation. The physician and other medical staff should remain sensitive to the family's concerns and the child's emotional adaptation. Counseling and open discussion of the psychosocial and sexual issues may greatly assist both the child and family. Making the correct diagnosis is critical to the selection of the appropriate form of therapy. Fortunately, in most cases in which therapy is warranted, it is extremely effective. In the remaining conditions, promising new forms of therapy are being investigated.
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