Premature thelarche, or the isolated onset of
breast development, is most commonly seen before age 4 years in girls.
Although this finding can represent the beginning of precocious puberty,
puberty in most affected girls does not progress, and the remainder of
pubertal development occurs at a normal age. Although the majority of cases
are idiopathic, an assessment of whether the child has ingested any
estrogen-containing medication can occasionally reveal a potential cause.
A bone age determination will help rule out accelerated growth that may be
associated with more serious conditions. Pelvic examination and breast biopsy
are contraindicated-pelvic examination because of the potential trauma involved
(pelvic ultrasound may be considered if indicated) and biopsy because of the
potential damage to the breast bud which could prevent future breast development.
Luteinizing hormone level is generally normal in these patients, although an
elevated follicle-stimulating hormone level is occasionally seen. Karyotype
analysis is not generally useful in determining the diagnosis.
- Bone age determination.
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Seminars in Medical Practice
Hospital Physician Board Review Manuals
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