The test that is considered the gold standard for the diagnosis of precocious puberty is GnRH, a minimally invasive test, substantially free of contraindications, which can be performed in day hospital
My daughter is 7 and a half years old and for a few months we have noticed breast growth. She had hormone tests to evaluate the presence of any precocious puberty and a pediatric endocrinologist prescribed GnRH (gonadotropin-releasing hormone) treatment; other doctors to disagree. How should we proceed? Is it possible to predict when menarche will arrive?
He answers Manuela Gasparripediatric endocrinologist, San Paolo Hospital, Asst Santi Paolo e Carlo, Milan (GO TO THE FORUM)
There diagnosis of central precocious puberty, defined as the activation of the hypothalamic-pituitary-gonadal axis in females before the age of 8 and in males before the age of 9, is based on clinical-laboratory-instrumental criteria which must not disregard the assessment of the child as a whole, including auxological parameters. Undoubtedly the suspicion must be placed in a little girl who presents thelarche (i.e. the appearance of a breast button) before the age of 8particularly if associated with signs of hormonal activation, acceleration of growth velocity and advancement of bone age.
Exams
In addition to the tests that have already been performed (basic hormonal tests, radiography of the carpus to determine the bone age and pelvic ultrasound to evaluate the internal genital organs), the test that is considered the gold standard for the diagnosis of precocious puberty is the GnRH test, which allows to evaluate the response of LH and FSH to the hormonal stimulus. It is a minimally invasive test, substantially free of contraindications, which can be performed in day hospital and is one of the elements for making the diagnosis of precocious puberty. The treatment is especially indicated in the forms of central precocious puberty with rapid progression, i.e. characterized by a rapid transition from one pubertal stage to the nextassociated with acceleration of growth velocity and significant advancement of bone age.
Stature
Next to the goal of reduce the psychological impact of the onset of menarche in an early period, the aim of therapy is to slow down skeletal maturation and favor the achievement of the final stature foreseen on the basis of the genetic target. In doubtful cases, it can be useful a short period of observation (3-6 months, depending on the clinical picture). On the basis of the available data provided by her alone, it is not possible to establish at what age her child will have menarche: it is important that you contact a pediatric endocrinologist which, on the basis of auxological, clinical, laboratory and instrumental criteria, is able to guide you in the evaluations/interpretations of the case, as in the possible therapeutic choice.
July 3, 2023 (change July 3, 2023 | 08:12)
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