Abstract Ref Number = APCP830
PERIPHERAL PRECOCIOUS PUBERTY IN A GIRL, TWO YEARS FOLLOW UP CASE REPORT
Riska Habriel Ruslie,Siska Mayasari Lubis
Endocrinology Division Department of Child Health Faculty of Medicine Universitas Sumatera Utara
Background : Peripheral precocious puberty is the onset of puberty before eight years in girls which is not associated with activation of the hypothalamus-pituitary-gonad axis. This reported a two years monitoring of a thirteen months old girl with idiopathic peripheral precocious puberty
Case Presentation Summary : Thirteen months girl came with vaginal bleeding since 2 months before admission. It proceeded with thelarche at six months and pubarche at nine months old. No remarkable past medical history was found. No significant family history of precocious puberty was found. Pubertal stage A2M3P2, no ambiguous genitalia. She was in the 50th percentile for height according to WHO growth chart and showed average bone age. Hormonal examinations showed estradiol elevation without gonadotropin elevation. An enlarged uterus was found in pelvic ultrasound, where its size was similar to pubertal-aged girl. Examinations were done to exclude the etiologies of peripheral precocious puberty such as pelvic scanning and MRI, adrenal ultrasound, 17- hydroxyprogesterone, cortisol, DHEA-S, prolactin, and thyroid hormones, but the results were normal and the etiology remains unclear. The patient was treated with 10 mg daily medroxyprogesterone acetate and showed clinical improvement. Her pubertal stage became A1M1P1 on sixth-month treatment, growth velocity appropriate to normal WHO growth chart, and estradiol level became normal according to her age. No bone mineralization disorder had been found during treatment.
Learning Points/Discussion : From those examinations we still could not find the etiology of this case, therefore it might be considered as idiopathic peripheral precocious puberty case, where according to many kinds of literature the cause usually identifiable. Monitoring of recurrence after treatment discontinuation, the onset of puberty when reaching her appropriate age, and her fertility were needed.
Keywords: precocious puberty idiopathic medroxyprogesterone acetate