SELF-REMITTING OR TRANSIENT CENTRAL PRECOCIOUS PUBERTY

We report on two girls with atypical, self-remitting central precociou s puberty and their subsequent development until (near) final height. Both showed thelarche prior to chronological age 4 years and an accele rated progressive bone maturation (delta bone age/delta chronological age 1.86 and 3.21, respectively). In patient 1, the hormonal findings were not typical for central precocious puberty (Gonadotropin-releasin g-hormone-stimulated LH/FSH ratio 0.54, estradiol 14 pg/ml). In patien t 2 the hormonal results were borderline (stimulated LH/FSH ratio 1.0, estradiol <5 pg/ml). During the next 5 years a spontaneous arrest of pubertal development was seen in patient 1 until normal puberty starte d at age 10 years (menarche 12.7 years). Patient 2 showed a complete r egression of pubertal signs until now (age 8 years). Both patients wer e not treated. Patient 1 reached a normal adult height (168 cm). The r emaining growth potential of patient 2 is favourable (height SDS for b one age). Discussion: A review of the literature on atypical central p recocious puberty showed that there is a continuum between the extreme s of isolated premature thelarche on one end and of progressive centra l precocious puberty at the other end of the spectrum. This variabilit y refers to the clinical appearance and also to bone maturation and ho rmonal findings. Even the progression of premature thelarche to overt central precocious puberty is possible. At initial evaluation a clear distinction between simple, non-progressive forms and aggressive, prog ressive forms is difficult. Thus,an observation period of several mont hs before initiation of treatment is necessary in order to establish a correct diagnosis,the necessity to treat,and a correct evaluation of the efficacy of treatment.