a female child 15 month. have her breast enlarged... plz suggest investigations and trreatment



Both breasts are enlarged , Fe sex. ISOSEXUAL PRECOCIOUS Puberty incomplete. Causes, central, peripheral, drugs. Do LH, FSH. and LH:FSH ratio. if >1 precocious puberty. Do GnRH stimulation. it tells central etiology. USS/CT abdomen for ovarian or adrenal tumours. MRI Brain.

Wonderful approach

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Look for other signs of puberty like pubic hair and accelerated bone growth. If these are absent, then it is BENIGN PREMATURE THELARCHE. It is appearance of breasts in females before the age of 3 years. It is not associated with other signs of puberty. In benign premature THELARCHE size of breasts remain constant in size or even regress. Females with this Condition attain there first menstrual period at a normal age. Precocious puberty is very rare in this age group. Follow up the child every 6 months to look for other signs of puberty. Counsel the parents that it is benign. U can do serum LH and FSH levels.

Excellent sir

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though it is tempting to label as precocious puberty,but we must get things into right perspective,first go history of any vaginal bleeding,with height for age,then axillary or public hair,x rays for bone age ,serum estradiol if everything above mentioned is normal then it is benign precocious thelarche,

both breasts are enlarged so she must be investigated for precocious puberty.complete hormonal assay is essential specially GH,FSH,LH complete physical examination ,CT,USG to exclude gonadal noradrenaline tumour

Isosexual Precocious..Incomplete puberty. Hormonsl studies and Braim MRI.

Rule out primary hypogonadism. LH, FSH,S S prolactin,s t3 t4 and TSH, . Undescended testes. If not testicular size.

Excessive oestrogen, wait & watch.

Precocious puberty

May will regreds with times. if not may needed investigayion

Hormonal assay,CT/USG abdomen and MRI head

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