CENTRAL PRECOCIOUS PUBERTY IN A 2-YEAR AND 2-MONTH OLD GIRL

Ikhsan Ali, Ratna Dewi Artati, R Satriono

Endocrinology division, Department of Child Health Medical School,
Hasanuddin University/Dr. Wahidin Sudirohusodo Hospital Makassar
Abstract
Background : Precocious puberty is the development of secondary sex
characterteristics that occur before the age of 8 years in a girl or before age 9
years in a boy. Central precocious puberty (CPP) caused by early activation of the
hypothalamic-pituitary-gonadal axis The prevalence of precocious puberty in
Denmark is about 10 times as high in girls as in boys. Gonadotropin releasing
hormone agonist (GnRHa) is the treatment of choice for CPP, that can
suppressive effect on the hypothalamic- pituitary-gonadal axis.
Objective : To report a case of CPP in a 2-year and 2-month old girl.
Case : A 2-year and 2-month old girl, presented with vaginal bleeding
(menstruation), breast development and occured pubic and axilla hair since 7
months of age. Physical examination found moderately ill with obesity, Tanner
stage was A2M3P2, caf au lait in left forehead with size 7x3,5cm. LH, FSH and
estradiol level was increased which are 4.32 mIU/ml, 6.01 mIU/ml and 67 pg/ml.
Pelvic ultrasonography showed suggestive precocious puberty, bone age showed
5-year and 9-month (according Greunlich and Pyle), CT-Scan of the brain showed
hypothalamic tumor suspected hypothalamic hamartoma. The treatment of this
patient was GnRHa injection every 4 week.
Conclusion : A case of CPP in a 2-year and 2-month old girl was reported. The
diagnosis was based on history taking, physical examination, laboratory and
radiological finding. The prognosis of this case is doubtful
Keyword : Central precocious puberty, hypothalamic hamartoma