title: Isosexual pseudoprecocious puberty in a 2(1/2)-year-old girl presenting with intense skin pigmentation.
abstract: BACKGROUND
  Ovarian follicular cyst producing estradiol is a rare cause of isosexual pseudoprecocious puberty. Intense pigmentation of breast papillae, areolae, and labia minora is also rarely reported in the literature.
  
  
  METHODS
  We describe a 2(1/2) year old girl presenting with signs of precocious puberty and advanced bone age due to a large follicular cyst. Estradiol and Dehydro-epiandrosterone sulfate (DHEAS) levels were remarkably elevated. Hyperpigmentation was also noted. Salpingoophorectomy resulted in regression of precocity and depigmentation, but DHEAS serum levels remained elevated.
  
  
  CONCLUSIONS
  High levels of circulating estradiol due to an ovarian follicle can induce precocious puberty and pigmentation of the skin which regresses after surgical removal of the cyst. Elevated DHEAS levels may be the initiating event causing the formation of the large follicular cyst.
authors.affiliation: 1st Department of Obstetrics and Gynecology, Alexandra Hospital, University of Athens, Athens, Greece. giannisbil@hotmail.com
authors.forename: Ioannis
authors.initials: I
authors.lastname: Biliatis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Thomakos
authors.forename: Chrisoula Panitsa
authors.initials: CP
authors.lastname: Faflia
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Akrivos
authors.forename: Aris
authors.initials: A
authors.lastname: Antsaklis
mesh_terms: D000365:Age Determination by Skeleton; D000738:Androsterone / Q000378:metabolism; D002675:Child, Preschool; D004958:Estradiol / Q000378:metabolism; D005260:Female; D005497:Follicular Cyst / Q000150:complications* / Q000378:metabolism; D006801:Humans; D010048:Ovarian Cysts / Q000150:complications* / Q000378:metabolism; D011629:Puberty, Precocious / Q000209:etiology*; D012880:Skin Pigmentation
chemical_list: D004958:Estradiol; D000738:Androsterone