MANAGEMENT OF SYMPTOMATIC FOLLICULAR CYST S IN YOUNG GIRLS

Background.-Ovarian cysts are common in childhood but most are non fun ctioning. Treatment of those follicular cysts that develop in young ch ildren may be difficult. Case reports Case n(o) 1.-A 1 1/2 month-old b aby was admitted because of an acute abdominal syn drome. Ultrasonogra phy showed a pelvic, heterogeneous mass without calcifications. Laparo tomy showed right ovarian torsion with necrosis of a cyst requiring ov ariectomy. At that rime, there was an isolated increase in FSH after L HRH stimulation. A transitory premature thelarche without pubertal typ e response to LHRH was seen at the age of 3 months. Clinical and ultra sonographic controls remain normal with a follow-up of 1 year. Case n( o) 2.-A 4 yr 10 m-old girl was admitted because of an acute abdominal syndrome. Ovariectomy was necessary because laparotomy showed right ov arian torsion with necrosis of a cyst. Recurrent abdominal pain, 4 mon ths later, was associated with an enlarged left ovary without sexual p recocity. Gonadotropin were slightly increased after LHRH stimulation and the patient was given LHRH agonist that suppressed endogenous LHRH within 3 months. Clinical and ultrasonographic controls remain normal 1 year after cessation of treatment. Case n(o) 3.-A 19 month-old girl was admitted because of a genital hemorrhage with recent development of secondary sexual characteristics. Skeletal age was 2 yrs. Ultrasono graphy showed an enlarged uterus and a left ovarian cyst, heterogenous with calcifications. Plasma levels of estradiol were increased but go nadotropin were normal. Ovariectomy was performed followed by disappea rance of secondary sexual characteristics. However, the patient was gi ven LHRH agonist at the age of 2 yr 7 mo because of recurrent pubertal activity. Conclusions.-These cases underline the difficulty in treati ng follicular cysts in young girls. The possibility of cyst recurrence with manifestations of pubertal activity after ovariectomy lead to di scuss indication of LHRH agonists for an undetermined duration.