Premature Thelarche
Premature Thelarche: Excerpt from The 5-Minute Pediatric Consult
Olga T. Hardy, MDAndrea Kelly, MD
Premature Thelarche - BASICS
Premature Thelarche - description
- Breast development <8 years of age in girls with no other signs of pubertal development
- A recent study suggested that African American girls are developing pubertal characteristics as early as age 6 and Caucasian girls as early as age 7. However, physicians should be cautious about using these as normal limits and should evaluate children on an individual basis because signs of puberty at these younger ages may not be normal.
Premature Thelarche - epidemiology
60% of cases noted between 6 months and 2 years of age
Premature Thelarche - pathophysiology
- Transient increases in follicle-stimulating hormone levels causing follicular ovarian development
- Low levels of estrogen secretion by normal follicular cysts
- Increased sensitivity of breast tissue to low levels of estrogen
Premature Thelarche - etiology
Intermittent estrogen secretion by ovarian cysts or environmental sources of estrogen
Premature Thelarche - DIAGNOSIS
Premature Thelarche - signs & symptoms
Premature Thelarche - history
- Careful assessment of onset and progression of breast tissue
- Family history of early puberty
- Exposure to estrogens
- Be sure to ask about ingestion of foods with high estrogen levels.
Premature Thelarche - physical exam
- Areolar enlargement is usually not present.
- Galactorrhea is not present.
- Palpate carefully to distinguish fat from true breast tissue.
- Look carefully for other signs of puberty:
- Menstrual blood
- Dull, gray-pink, or rugose vaginal mucosa (vs. prepubertal appearance: Shiny, bright red, and smooth)
- Pubic or axillary hair
- Inspect skin for birthmarks suggestive of McCune–Albright syndrome (café au lait spots in a coast of Maine pattern).
- Evaluate for signs of hypothyroidism: Goiter, short stature
Premature Thelarche - tests
Premature Thelarche - lab
- No test is specific.
- Serum follicle-stimulating hormone, inhibin B, and estradiol may be slightly higher than age-matched controls, but are not consistently elevated.
- In isolated premature thelarche, serum ultrasensitive luteinizing hormone is prepubertal.
Premature Thelarche - imaging
- Bone age is not significantly or very mildly advanced (<1 year ahead of chronologic age). Useful in guiding the need for more intensive evaluation of true precocious puberty
- Pelvic ultrasonography may demonstrate presence and regression of small ovarian cysts (1–15 mm) and a prepubertal uterus.
Premature Thelarche - differencial diagnosis
- Environmental:
- Exposure to exogenous estrogens in the form of creams or birth control pills
- Intake of food with high estrogen levels (e.g., chicken liver)
- Tumors: Benign lipomas
- Congenital: Neonatal breast hyperplasia is benign breast enlargement in newborn boys or girls that is apparent shortly after birth and is caused by gestational hormones. This form of breast development usually regresses.
- Other:
- Severe acquired hypothyroidism: High levels of thyroid-stimulating hormone may cross-stimulate gonadal follicle-stimulating hormone and/or luteinizing hormone receptors.
- McCune–Albright syndrome: Triad of precocious puberty, café au lait spots, and polyostotic fibrous dysplasia due to gain of function mutations of G proteins
- True precocious puberty
- Must distinguish fat from breast tissue in obese girls
- Removal of a breast bud will result in failure of that breast to develop during adolescence
Premature Thelarche - TREATMENT
Premature Thelarche - general measures
- Observation
- Reassurance that this is a benign process
Premature Thelarche - FOLLOW UP
- Regression may occur up to 6 years after onset.
- Evidence of pubertal progression should prompt additional evaluation by an endocrinologist:
- Rapid increase in size of breast tissue
- Vaginal bleeding
- Growth spurt
- Development of pubic and axillary hair
Premature Thelarche - prognosis
- No known effects on growth or fertility
- Onset after age 2 years may be associated with increased risk of progression to precocious puberty.
Premature Thelarche - complications
May be the 1st sign of precocious puberty
Premature Thelarche - bibliography
- Crofton PM, Evans NEM, Wardhaugh B, et al. Evidence for increased ovarian follicular activity in girls with premature thelarche. Clin Endocrinol. 2005;62:205–209.
- Haber HP, Wollmann HA, Ranke MB. Pelvic ultrasonography: Early differentiation between isolated premature thelarche and central precocious puberty. Eur J Pediatr. 1997;154:182–186. Comment in Eur J Pediatr. 1997;156:78–79.
- Herman-Giddens ME, Slora EJ, Wasserman RC, et al. Secondary sexual characteristics and menses in young girls seen in office practice: A study from the Pediatric Research Office in Settings Network. Pediatrics. 1997;99:505–512.
- Kaplowitz P, Oberfield SE, Drug and Therapeutics and Executive Committees of the Lawson Wilkins Pediatric Endocrine Society. Reexamination of the age limit for defining when puberty is precocious in girls in the United States: Implications for evaluation and treatment. Pediatrics. 1999;104:936–941.
- Klein K, Mericq V, Brown-Dawson JM, et al. Estrogen levels in girls with premature thelarche compared with normal prepubertal girls as determined by an ultrasensitive recombinant cell bioassay. J Pediatr. 1999;134:190–192.
- Lebrethon MC, Bourguignon JP. Management of central isosexual precocity: Diagnosis, treatment, outcome. Curr Opin Pediatr. 2000;12:394–399.
- Midyett LK, Moore WV, Jacobson JD. Are pubertal changes in girls before age 8 benign? Pediatrics. 2003;111:47–51.
- Pasquino AM, Pucarelli I, Passeri F, et al. Progression of premature thelarche to central precocious puberty. J Pediatr. 1995;126:11–14. Comment in J Pediatr. 1995;127:336–337.
- Salardi S, Cacciari E, Mainetti B, et al. Outcome of premature thelarche: Relation to puberty and final height. Arch Dis Child. 1998;79:173–174.
- Stanhope R. Premature thelarche: Clinical follow-up and indication for treatment. J Pediatr Endocrinol Metab. 2000;13(suppl 1):827–830.
- Styne DM. New aspects in the diagnosis and treatment of pubertal disorders. Pediatr Clin North Am. 1997;44:505–529.
- Traggiai C, Stanhope R. Disorders of pubertal development. Best Pract Res Clin Obstet Gynaecol. 2003;17:41–56.
Premature Thelarche - CODES
Premature Thelarche - icd9
- 259.1 Precocious sexual development and puberty, not elsewhere classified
- 778.7 Neonatal breast hyperplasia
Premature Thelarche - PATIENT TEACHING-MED
- No data to suggest that premature thelarche increases the risk of breast cancer
- Many newborn male and female infants have breast buds as a result of exposure to maternal estrogen in utero. This neonatal gynecomastia usually resolves quickly.
- Asymmetric breast development is quite common in the early stages of normal pubertal development. Malignant tumors of the breast during childhood are extremely rare. As mentioned earlier, any removal of breast tissue prior to or during puberty must be avoided if possible.
Premature Thelarche - FAQ
- Q: Does premature thelarche predispose the child to abnormalities in pubertal development?
- A: If onset occurs after age 2 years, the girl may be more likely to enter puberty earlier. However, most girls with premature thelarche will have normal pubertal development and fertility.
>>
Book Source Details
- Book Title: The 5-Minute Pediatric Consult
- Author(s): M. William Schwartz MD; et al.
- Year of Publication: 2008
- Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.
More About Abruptio Placentae
More Medical Textbooks Online about Abruptio Placentae
Review other book chapters online related to Abruptio Placentae:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
|
|
More About This Book:
Title: The 5-Minute Pediatric Consult
Authors: M. William Schwartz MD; et al.
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7577-9
|
|
» Next page: Surveys relating to Abruptio Placentae
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
