Dayal Devi, Seetharaman Keerthivasan, Menon Prema, Aggarwal Anshita, Das Gargi, Srinivasan Radhika
Endocrinology and Diabetes Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Paediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Pediatr Endocrinol Diabetes Metab. 2019;25(2):90-94. doi: 10.5114/pedm.2019.85820.
We present a rare occurrence of precocious puberty (PP) probably due to an autonomous ovarian cyst in a 15-month-old girl who presented to us with growth spurt, breast and pubic hair development, and vaginal bleeding over the last few months. The clinical presentation was suggestive of central precocious puberty (CPP). However, the rapid progression of pubertal changes and occurrence of menarche at breast Tanner stage 2 indicated peripheral precocious puberty (PPP). Due to uncertainty of clinical diagnosis, investigations were conducted for CPP as well as PPP. The basal and peak stimulated LH concentrations were < 0.3 IU/l and < 2 IU/l, respectively, indicating PPP. However, the peak LH : FSH ratio was > 1, which is consistent with CPP. Abdominal imaging revealed an ovarian mass, which was laparoscopically excised, but the true nature of the mass could not be ascertained because the excised specimen showed only haemorrhage and features of ovarian torsion on histopathological examination. Regression of pubertal development occurred over a three-month period postoperatively.
我们报告了一例罕见的性早熟病例，病因可能是一名15个月大女童的自主性卵巢囊肿。该女童在过去几个月出现生长加速、乳房和阴毛发育以及阴道出血。临床表现提示中枢性性早熟（CPP）。然而，青春期变化的快速进展以及在乳房坦纳2期出现月经初潮表明是外周性性早熟（PPP）。由于临床诊断存在不确定性，因此对CPP和PPP都进行了检查。基础促黄体生成素（LH）浓度和峰值刺激后LH浓度分别<0.3 IU/l和<2 IU/l，提示PPP。然而，LH峰值与卵泡刺激素（FSH）的比值>1，这与CPP一致。腹部影像学检查发现一个卵巢肿物，通过腹腔镜将其切除，但由于切除标本在组织病理学检查中仅显示出血和卵巢扭转特征，肿物的真正性质无法确定。术后三个月青春期发育出现消退。
