Unsustained or slowly progressive puberty in young girls: Initial presentation and long-term follow-up of 20 untreated patients

A small number of young girls with unsustained or slowly progressive pubert y have been described, but few data regarding their final heights and adult reproductive function have been reported. We have conducted a study that delineates the initial presentation and 12-y r follow-up of 20 patients who initially presented with unsustained or slow ly progressive puberty as young girls. The patients were first seen between 1984-1987. They all underwent extensive clinical and hormonal studies, inc luding frequent blood sampling and pelvic ultrasound to characterize pituit ary-gonadal function. Twelve years later, we were able to locate 17 of the patients, and 16 of these agreed to participate in a questionnaire-based fo llow-up study. Follow-up data about the other patients were gleaned from av ailable medical records as were corroborative data regarding the 16 study p articipants. Our results indicate that this form of early puberty is a benign entity. Se venty percent of our patients experienced cessation of their early pubertal development, whereas the remainder reported a slowly progressive course. T hose with a slowly progressive course were older than those with an unsusta ined course [mean age of thelarche, 6.1 vs. 3.4 yr (P < 0.01); age of pubar che, 6.0 us. 4.0 yr (P = 0.02); age at our evaluation, 7.1 us. 5.2 yr (P = 0.02)]. They also had more advanced skeletal maturation (bone age, 10.2 us. 7.3 yr; P = 0.04) at the time of our evaluation. Both groups, however, had similar outcomes with respect to linear growth and young adult reproductiv e function. On the average, the study patients reached their genetic target s for final height (mean final height, 165.5 +/- 2.2 cm; mean genetic targe t height, 164.0 +/- 1.1 cm; P = NS). The average age of menarche was 11.0 /- 0.4 yr. Twenty-three percent of our patients have evidence of anovulator y menstrual cycles, which is comparable to the 28% found in normative studi es of similarly aged women. Two of the patients have become pregnant to dat e. Unsustained or slowly progressive puberty in young girls does not warran t therapy with GnRH agonists. Thus, when evaluating patients with early pub ertal development, one should ensure that sexual maturation is continually progressive before initiating potentially unnecessary therapy.