Precocious puberty in girls
Baby S P, a 6-year-old girl, presented with progressive bilateral breast enlargement for 7 months, cyclical vaginal bleeding (3/25-30days) for 4 months and pubic hair development was noted for 2 months. There was no clitoral enlargement, neck swelling, pigmented skin marks, bone pain/fractures. There was h/o recent increase in height in the last 1 year. She had no significant medical illness or radiation exposure in the past. Her birth and neonatal period were normal. Her milestones were normal for her age.\nOn examination, her vitals were normal. There was no thyroid swelling, café au lait spots or any bony abnormality noted. Tanners staging was B3P3. There was no axillary hair or genital ambiguity. Cardiac, thoracic and neurological examinations were normal. Examination of the abdomen was normal.\nHer investigations showed normal hemogram, liver and renal functions. Her bone age, height age and chorological age were respectively 7.8 year, 7 year (119 cm) and 6 year. Thyroid functions were normal. Her hormonal profile was as follows: LH < 0.1 mIU/ml, FSH < 0.1 mIU/ml, Testosterone 0.334 ng/ml, DHEAS 17.9 μg/dl, Estradiol > 162.8 pg/ml.\nCT pelvis showed a bulky left ovary of size 5.4 cm predominantly solid with follicles seen at periphery and pubertal uterus.\nShe underwent laparascopic resection of right tuboovarian mass which on histopathology was mixed germ cell sex cord stromal tumor. Post-operatively, child had withdrawal vaginal bleeding on day 4 of surgery lasting 72 h. Repeat hormonal profile done on 6th post-operative day showed markedly reduced Estradiol levels 14.37 pg/ml, LH <0.184 mIU/ml, FSH 0.25 mIU/ml, testosterone 0.025 ng/ml, DHEAS 9.87 μg/dl. At 6 months follow-up, there was no vaginal bleeding so far.