Toublanc J E
Département de pédiatrie, Hôpital Saint-Vincent-de-Paul, Paris.
Contracept Fertil Sex. 1994 Mar;22(3):173-7.
Occurrence of any pubertal sign before eight years of age defines premature sexual development but does not always mean precocious puberty (PP); one should distinguish borderline physiological situations which need only a follow-up and frankly pathological situations which need very precise investigations and suitable treatment. The first situations are premature thelarche, pubarche and menarche in which the height and bone maturation, pelvic ultrasonography (US) are normal for age, avoiding hormonal investigations. Conversely in the second situation, the bone age is more advanced than the height age and the pelvic US displays ovarian activity and uterine development. The next step is the characterization of the level of the mechanism of puberty: hypothalamohypophysal or ovarian: in the first case gonadotropin levels are elevated after GnRH infusion, in the second case, depressed. The aetiological diagnosis are in true PP: brain tumors malformations or hamartoma even if negative idiopathic. At ovarian level: ovarian tumors or McCune Albright syndrome or recurrent cysts. The first etiology leads to use GnRH analog in the second the treatment is more delicate.
八岁前出现任何青春期体征定义为性早熟，但并不总是意味着真性性早熟（PP）；应区分仅需随访的临界生理情况和需要非常精确检查及适当治疗的明显病理情况。第一种情况是青春期乳房过早发育、阴毛过早生长和月经初潮过早，其中身高和骨成熟度、盆腔超声（US）在相应年龄正常，无需进行激素检查。相反，在第二种情况下，骨龄比身高年龄更超前，盆腔超声显示卵巢活动和子宫发育。下一步是确定青春期机制的水平：下丘脑 - 垂体性或卵巢性：在第一种情况下，GnRH注射后促性腺激素水平升高，在第二种情况下则降低。真性PP的病因诊断包括：脑肿瘤、畸形或错构瘤，即使病因不明也为特发性。在卵巢层面：卵巢肿瘤、McCune - Albright综合征或复发性囊肿。第一种病因导致使用GnRH类似物，第二种病因的治疗则更为复杂。
