A case of premature thelarche with no central cause or genetic variants within the estrogen receptor signaling pathway.
BACKGROUND
Premature thelarche is defined as breast development before 8 years of age. This is most often caused by central hormone disregulation and is accompanied by concurrent bone maturation. However, we present a case of premature thelarche with concurrent bone maturation without central hormone disregulation. Genes within the estrogen signaling pathway were examined for genetic changes which might be responsible for the clinical phenotype.


METHODS
A girl presented with breast development from 18 months of age with undetectable serum estrogens, prepubertal serum gonadotropins, advanced growth and skeletal maturation, but no increase of uterine size, thus presenting a premature thelarche variant. Serum estrogens remained below detectable limits until she entered into an unremarkable puberty at 12.1 years of age. No abnormalities or SNPs were found in the genes tested.


CONCLUSIONS
We describe a case of premature thelarche which cannot be attributed to a central cause of abnormal hormone levels or to alterations in genes suspected for this phenotype. We conclude that other yet to be identified factors are involved in this unique case of premature thelarche.
Lester & Sue Smith Breast Center, Baylor College ofMedicine, Houston, TX, USA.
R J
RJ
Hartmaier
M J E
MJ
Walenkamp
A S
AS
Richter
J
J
Wang
B S
BS
Katzenellenbogen
S
S
Oesterreich
J M
JM
Wit
D000293:Adolescent; D001940:Breast / Q000254:growth & development*; D002648:Child; D002675:Child, Preschool; D004252:DNA Mutational Analysis; D004967:Estrogens / Q000097:blood; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D020641:Polymorphism, Single Nucleotide; D011629:Puberty, Precocious / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D011960:Receptors, Estrogen / Q000235:genetics / Q000378:metabolism; D015398:Signal Transduction
D004967:Estrogens; D011960:Receptors, Estrogen