-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Precocious puberty From: Mark Perloe (mperloe@ivf.com) Mon Jan 21 15:04:56 2002 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Hans van der Slikke: "Looking for Mirena users in Europe !! Please help me...." Previous message: jafar6: "Re: Lacerations associated with vaginal deliveries" In reply to: Sandeep Sharma: "Precocious puberty" A wonderful review of precocious puberty can be found at this URL http://www.aafp.org/afp/990700ap/209.html Please ask the following questions before determining treatment. Is this gonadotropin dependent precocious puberty? ie, has the pituitary access matured prematurely. This patient usually follows the normal pubertal course of development but with earlier onset. This would not likely be the case with a young girl who remains at Tanner stage I. What is the bone age? Is it advanced. Usually the bone age will be roughly 12 at the onset of menses? Gonadotropin (FSH or LH) tumors are rare, but hCG tumors may be seen peripherally. Is development isosexual or are signs of masculinization or androgenization present? If so, suspect adrenal tumor or enzyme defect as well as ovarian androgen producing tumor. Women with PCOS and pubertal type II DM will frequently experience precocious puberty and often present with premature adrenarche. Leptin levels and bone age will be elevated in these young girls. Is a peripheral or exogenous source of estrogen/androgens present? Has there been a history of multiple bone fractures? (McKune-Albright) Consider the following FSH, LH, hCG, TSH, Estradiol, (Testosterone & 17OHProgesterone if hirsute), MRI of hypothalamus and pituitary with contrast, ultrasound of the ovary, and if androgens are elevated, either high resolution ultrasound, or MRI of the adrenal gland should be added. Xrays of extremities if McKune-Albright is suspected clinically. If gonadotropins are elevated and bone age films do not indicate epiphyseal closure, then GnRH-agonists and growth hormone therapy should be considered. At 06:18 AM 1/21/2002 -0600, you wrote: >I have seen a patient who has started her periods at the age of 9yrs >5months.Tanner stage I.She is 4ft 10 inches tall. Her father is 6ft >tall and her mother 5ft 6inches. Does she warrant GnRH analogues to >help her achieve a normal height? I will be grateful if someone can >share their experience. >SS -- Mark Perloe, M.D. http://grs.ivf.com 404-843-2229 5445 Meridian Mark Rd, Suite 270, Atlanta, GA 30342 Live Chat Wednesday evenings 8:00-9:00 p.m. ET http://infertility.about.com/gi/chat/cs.htm Next message: Hans van der Slikke: "Looking for Mirena users in Europe !! Please help me...." Previous message: jafar6: "Re: Lacerations associated with vaginal deliveries" In reply to: Sandeep Sharma: "Precocious puberty"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 04:50:52 2009

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.