Precocious puberty: how about the accelerated bone maturation?

Abstract

Introduction. Precocious puberty is a common endocrine disorder in pediatric patients, leading to important changes in growth patterns. Case presentation. We present the case of a patient with precocious puberty and accelerated bone maturation, evaluated in several medical centers. A 9-year-and-11-month-old female patient was evaluated for premature thelarche, adrenarche and menarche starting at the age of 7. On clinical examination, height was 143 cm, 0.9 SD above the age and sex median, with 37.91% excess weight. She also presented with acne, cervical posterior acanthosis nigricans, hirsutism and Tanner puberty development stage B3/P4. The endocrine profile showed pubertal values for FSH (Follicle-Stimulating Hormone), LH (Luteinizing Hormone) and estradiol, before and after the Diphereline test, hyperprolactinemia (of 38.6 ng/mL, normal: 2-18.9 ng/mL) and high levels of 17-OH Progesterone (of 2.60 ng/mL, normal: 0.2-0.9 ng/mL). The Synactene® test excluded 21-hydroxylase deficiency. Knee X-rays showed a tendency for premature growth plate fusion and bone age advancement of 3.1 years. Gynecological examination and pelvic ultrasound showed normal ovarian morphology and volume, according to chronological age and a 17-mm endometrium. Hypothalamic-pituitary MRI (Magnetic Resonance Imaging) excluded the presence of a local lesion. Conclusions. In the absence of therapeutic intervention, accelerated skeletal development due to precocious puberty initially leads to high stature compared to the patient’s age group, followed by premature closure of the growth plates and low final height.

Keywords

• precocious puberty
• bone age
• diphereline