Precocious puberty in girls
Baby R K, 3-year-old girl, presented with progressive bilateral breast enlargement over 1 year, irregular vaginal bleeding for 10 months and pubic hair development for 2 months. There was no clitoral enlargement, neck swelling, pigmented skin marks, bone pain/fractures. Parents could not comment on any recent height gain. 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. Tanners staging was B3P3. There was no axillary hair or genital ambiguity. Cardiac, thoracic and neurological examinations were normal. A solitary well defined pelvic mass firm to hard, mobile was palpable in right lower abdomen.\nHer investigations showed normal hemogram, liver and renal functions. Her bone age, height age and chorological age were respectively 8 year, 10 months, 4 year (100 cm) and 3 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 17.97 μg/dl, Estradiol >1000 pg/ml.\nComputed Tomography (CT) pelvis showed a heterogeneously enhancing abdomino-pelvic mass.\nShe underwent resection of right tubo-ovarian mass, which was suggestive of juvenile granulose cell tumor. Post-operatively, child had withdrawal vaginal bleeding on day 2 of surgery lasting 48 h. Repeat hormonal profile done on 6th post-operative day showed markedly reduced Estradiol levels 17 pg/ml, LH <0.1 mIU/ml, FSH 0.1 mIU/ml, testosterone 0.025 ng/ml, DHEAS 0.947 μg/dl. She is now 6 months post-surgery. There was no vaginal bleeding so far.