Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty.
OBJECTIVE
Two groups of girls with premature breast development were studied retrospectively. We tried to identify clinical, radiological, and hormonal parameters that could distinguish between a benign, nonprogressive premature thelarche and a true precocious puberty.


METHODS
The clinical outcome of 88 girls with breast enlargement before 6.1 years of age was analyzed. Taking into account the progression of their sexual maturation, we allocated the children into 2 groups: "Isolated Premature Thelarche" (n = 63) and "Precocious Puberty" (n = 25) groups. Chronological and bone ages, height and growth velocity centiles, computerized tomography of hypothalamus-pituitary area, pelvic ultrasonography, gonadotropin response to luteinizing hormone-releasing hormone stimulation as well as basal levels of luteinizing hormone, follicle-stimulating hormone, estradiol, and prolactin were studied in both groups. Statistical analysis were performed using the Student t test to compare the sample means. Fisher's exact test and chi2 test were used to analyze the nonparametric variables.


RESULTS
Isolated premature thelarche most frequently affected girls younger than 2 years who presented exaggerated follicle-stimulating hormone response to luteinizing hormone-releasing hormone stimulation test. The precocious puberty group had higher initial stature, accelerated growth rate and bone age, increased uterine and ovarian volumes, high spontaneous luteinizing hormone levels by immunofluorimetric assay, as well as a high luteinizing hormone response and peak luteinizing hormone/follicle-stimulating hormone ratio after luteinizing hormone-releasing hormone stimulation.


CONCLUSIONS
At initial presentation, girls who undergo true precocious puberty present advanced bone age, increased uterine and ovarian volumes in addition to breast enlargement, as well as an luteinizing hormone-predominant response after a luteinizing hormone-releasing hormone stimulation test.
Della Manna
Thais
T
Unit of the Children's Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil.
Setian
Nuvarte
N
Damiani
Durval
D
Kuperman
Hilton
H
Dichtchekenian
Vaê
V
D000365:Age Determination by Skeleton; D017668:Age of Onset; D000886:Anthropometry; D001940:Breast / Q000254:growth & development*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004958:Estradiol / Q000097:blood*; D005260:Female; D006065:Gonadotropins, Pituitary / Q000097:blood*; D006801:Humans; D011629:Puberty, Precocious / Q000097:blood / Q000175:diagnosis*; D012189:Retrospective Studies
D006065:Gonadotropins, Pituitary; D004958:Estradiol