VCOM Louisiana Research Day Program

Clinical & Case Studies

Amy Majorana, MA, OMS-III Edward Via College of Osteopathic Medicine-Louisiana 22 INCIDENTAL FINDING OF IDIOPATHIC CENTRAL PRECOCIOUS PUBERTY IN A FEMALE CHILD

Context/Impact: Precocious puberty is the development of secondary sexual characteristics in a pre-pubescent child and can be of central or peripheral etiology. The diagnosis and etiology is primarily made via gonadotrophin and sex hormone levels, with further workup based on these findings. Report of Case: The patient is a 5-year-old black female presenting with Tanner II/III stage breasts. She was above the 90 th percentile for height and weight and appeared older than stated age. The mother noticed breast changes 4 months prior. Her past medical history was noncontributory. Her luteinizing hormone (LH) and prolactin levels were elevated, and her estradiol was low, indicating central etiology. Other labs were within normal limits. A bone age study was completed showing skeletal and chronologic age compatibility. Endocrinology was consulted and a brain MRI was ordered. Imaging did not indicate abnormalities. The patient was referred to endocrinology but has not been evaluated and started on therapy. The most likely treatment is discussed instead. Treatment involves a gonadotrophin releasing hormone (GnRH) agonist. Medications are

administered as injections and prescribed until age 10-12, then stopped to allow puberty to restart. GnRH testing is done 4 months after starting treatment, then annually to ensure decreasing LH. Signs of successful treatment include slowed growth and shrinking breast tissue. Comments/Conclusion: Other case reports and retrospective studies have similar patient presentations with enlarged breasts before age 8. Additional symptoms included vaginal bleeding, pubic hair development, and accelerated growth velocity. Most published case studies describe specific etiologies for precocious puberty. Other studies have explored associations with underlying chronic conditions. These scenarios are less pertinent as this patient’s disease is idiopathic. Two case studies on idiopathic precocious puberty suggested an association between disease and environmental pollutants as endocrine-disrupting chemicals. Diagnostic workup was similar for all case reports. Lab tests and bone age confirmed the diagnosis and guided further studies. Patients with an underlying cause for disease were treated accordingly, with some cases still involving the use of GnRH agonists. One idiopathic case was treated with GnRH agonists;

the other did not include the treatment.

35 2023 Via Research Recognition Day