Open AccessVariantes normales del desarrollo puberal y pubertad precoz: Análisis de dos casos clínicos
Author(s) -
Lucía Rivero,
Carlos Zuníno,
María Noel Cuadro,
Gustavo Giachetto
Publication year - 2016
Publication title -
revista facultad de ciencias de la salud udes
Language(s) - English
Resource type - Journals
ISSN - 2422-1074
DOI - 10.20320/rfcsudes.v3i1.110
Subject(s) - pubic hair , medicine , bone age , precocious puberty , menarche , breast development , gynecomastia , clitoris , girl , pediatrics , secondary sex characteristic , sexual maturity , gynecology , endocrinology , surgery , hormone , psychology , developmental psychology
Precocious puberty is defined as the appearance of secondary sexual characteristics before the age of 8 in girls and 9 in boys. Objective: Emphasize the Pediatrician´s role in the diagnosis, treatment and follow-up of patients with precocious puberty. Description: Case 1: Girl, 4 years and 11 months old. Thin and scarce pubic hair since 6 months of age. No hypertrophy of the clitoris or breast. Overweight. Normal growth rate and neurodevelopment. Examination: scarce curly pubic hair, non-estrogenic mucosa. Increase in breast size. Breast ultrasound shows lipomatosis. Bone age: 5 years. Case 2: Girl, 6 years and 11 months old. Painful bilateral and symmetric breast growth, no galactorrhea. Oppressive, moderate and non-progressive headache. No intracranial hypertension. Pubarche, no menarche. Adequate neurodevelopment. Obese. Growth rate above the 90 percentile. Tanner III. Non-estrogenic genital mucosa. Bone age: 13 years. Gynecological ultrasound shows prepubertal uterus. Normal FSH, LH, estradiol, prolactin, TSH, T4 and cranial MRI. Treatment is initiated with leuprolide acetate. Discussion The appearance of thelarche, pubarche or menarche in patients with normal bone age, as in Case 1, constitutes an ordinary variation of puberty. However, as shown in Case 2, the presence of multiple sexual characteristics and advanced bone age must be considered as precocious puberty indicators. Pediatricians have an important role in the diagnosis and treatment of precocious puberty, as well as in the patient´s follow-up. Both anamnesis and physical examination are key to guide the diagnosis.