PROGRESSION OF PREMATURE THELARCHE TO CENTRAL PRECOCIOUS PUBERTY

To evaluate whether girls with premature thelarche progress to central precocious puberty (CPP) and to analyze their clinical and hormonal c haracteristics, we retrospectively examined 100 girls with premature t helarche who were followed for several years. Fourteen of the patients with characteristics diagnostic of premature thelarche (isolated brea st development before age 8 years, bone age advancement within 2 SD of normal, normal growth velocity, follicle-stimulating hormone-predomin ant response to luteinizing hormone-releasing hormone) progressed duri ng follow-up to precocious or early central puberty (progressive breas t size increase, bone age acceleration, and significant decrease in pr edicted adult height). The chronologic age of this group of 14 girls w as 5.1 +/- 2.0 years at the onset of premature thelarche and 7.8 +/- 0 .6 years (mean +/- SD) after progression to central early or precociou s puberty. Pelvic ultrasonography showed significant differences in me asurements between the time of diagnosis of premature thelarche and pr ogression to CPP. Nine of these patients required treatment, three wit h cyproterone acetate and six with luteinizing hormone-releasing hormo ne analogs, and all responded as expected for could be established tha t separated the 14 children who progressed to preconcious or early pub erty from the 86 girls who did not. We conclude that premature thelarc he is not always a self-limited condition and may sometimes accelerate the timing of puberty.