dear seniors, please help me in diagnosis and management of this case,a 6yr old girl with spotting p/vfor 1yrevery 2to 3mthsand leukorrhea,informant mother,scan report is attached,thank you



Precocious puberty ,uterus size n ET? LH FSH PL TSH 17 OHP ESTROGEN MRI BRAIN.Consider leuprolide Inj and monitor growth as early fusion n stunted growth is an issue.what abt Sec sexual characteristics ?is there thelarche pubarche or adrenarche ?U need to do Tanners staging.XR wrists for bone age.

what abt secondary sexual charecteristics

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it's precocious puberty whether it's central or peripheral we need to do Gnrh stimulation also has to look for her advanced bone age and other hormonal profile like basal and stimulated LH FSH Estrogen Prolactin.and THyoid profile. mostly she needs treatment with Gnrh analogue like fluoride acetate injection depending upon Gnrh stimulation and bone age advancement.

precocious puberty is definite here but only rt ovary is enlarged, lt is normal. may be ovarian cyst or ovarian tumor. What about secondary sexual characteristics in this patient. She needs thorough investigation and proper treatment at right time to preserve height potential.

She is case of precocious puberty. what are ht wt and secondary sexual characters. hypothyroidism is very important cause of precocious puberty all hormone assay should be done lf headache and visual disturbances are there CT or MRI brain should be done to rule out brain tumor. certain cosmetic contains oestrogen which may cause precocious puberty

for spotting pv please also consider the angle of sexual abuse... we often overlook this aspect, assuming parents or the guardian's of the child are harmless

rule out germcell tumours, & also foreign body vagina.

Wait & watch.

what about breast development? is there any sign of premature thelarche? if present it may b a case of precious puberty, for diagnosis hormonal profile is necessary FSH, LH, and prolactin levels test. for further treatment.

no breast development

thank you and will let you know the harmone profile

there's no development of sec sexual characters

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