What does “isolated Premature
Thelarche” means?
,To all of us it(PT) appears to mostly a benign, self-limiting condition which is characterized by breast development with no other signs of sexual maturation. As understandable, there will be no pubic or axillary hair development, girls behavior at home and at school is normal, growth is normal and the skeletal age is appropriate. But the breast development has atypical appearance with relatively immature nipple development and is never more than Tanner Breast Stage III. Breast development is usually asymmetrical.
,To all of us it(PT) appears to mostly a benign, self-limiting condition which is characterized by breast development with no other signs of sexual maturation. As understandable, there will be no pubic or axillary hair development, girls behavior at home and at school is normal, growth is normal and the skeletal age is appropriate. But the breast development has atypical appearance with relatively immature nipple development and is never more than Tanner Breast Stage III. Breast development is usually asymmetrical.
The condition tends to resolve after about 1–2 years and then
the onset of normal puberty(adrenarche, Menarche, increments f Ht & other
growth spurt )occurs at the appropriate
age and in the normal way. Very occasionally, vaginal bleeding can occur. There
have been some reports of women who have had premature thelarche as a child
developing large follicular cysts during their menstrual cycles and, thereby,
having reduced fertility. However, this has not been substantiated and what
limited follow-up has been achieved in further series suggests that there are
no long-term sequelae.
Etiology ? Isolated premature thelarche is a relatively common condition
and mothers come to doctors more will be recorded prevalence!! It is characterised by FSH dominance and
overnight gonadotrophin secretion, which is characterised by single FSH pulses.
There may well be two types of premature thelarche. The
classical type commences during the first year of life and tends to resolve by
the age of 2.
There is a second form of premature thelarche, of which the age
of onset is over 2 years of age and this tends to be more persistent and with a
higher incidence of uterine bleeding. In this ‘non-classical’ form of premature
thelarche, it may well be associated with progression to
gonadotrophin-dependent precocious puberty. Isolated premature thelarche is a
condition which is easy to diagnose clinically and requires no treatment.
Precocious Puberty (Complete, Partial)
Girls suspected of having central precocious puberty, are
otherwise healthy children whose pubertal maturation begins at the early end of
the normal distribution curve.
CNS imaging studies of
these otherwise healthy 6-year-old to 8-year-old girls usually reveal no
structural abnormalities. A study of 200 girls in France identified abnormal
brain imaging findings in 2% of girls whose onset of puberty was between age
6-8 years and in 20% of girls whose onset of puberty was before age 6 years.
[1] A smaller
study from the United Kingdom reported abnormal findings in 15% of 67 girls.[2] Abnormal
CT scan or MRI findings are more frequent among boys with central precocious
puberty than among girls with central precocious puberty.
The onset of puberty is caused by the secretion of high-amplitude
pulses of gonadotropin-releasing hormone (GnRH) by the hypothalamus. The
hypothesize HPG axis, which is highly sensitive to feedback inhibition by small
amounts of sex steroids, and (2) central neural pathways that suppress the
release of GnRH pulses.
Admittedly, I am more theoretician: Very very associate or should
I say etiology of PT:- CNS abnormalities
associated with precocious puberty include the following:
·
Hypothalamic hamartomas
·
Acquired CNS injury caused by inflammation, surgery, trauma,
radiation therapy, or abscess
·
Congenital anomalies (eg, hydrocephalus, arachnoid cysts,
suprasellar cysts)
High-amplitude pulses of GnRH cause pulsatile increases in the
pituitary gonadotropin-luteinizing hormone (LH) and follicle-stimulating
hormone (FSH). Increased LH levels stimulate production of sex steroids by
testicular Leydig cells or ovarian granulosa cells. Pubertal levels of androgens
or estrogens cause the physical changes of puberty, including d mechanisms that
suppress onset of puberty include (1) the gonadotropin-releasing hormone (GnRH)
by the hypothalamus. The hypothesize HPG axis, which is highly sensitive to
feedback inhibition by small amounts of sex steroids, and (2) central neural
pathways that suppress the release of GnRH pulses. On ultrasound the ovaries are small, but often contain
large follicular cysts, which increase and decrease in synchrony with the
breast development.
CNS abnormalities associated with precocious puberty include the
following:
·
Hypothalamic hamartomas
·
Acquired CNS injury caused by inflammation, surgery, trauma,
radiation therapy, or abscess
·
Congenital anomalies (eg, hydrocephalus, arachnoid cysts,
suprasellar cysts)
High-amplitude pulses of GnRH cause pulsatile
increases in the pituitary gonadotropin-luteinizing hormone (LH) and
follicle-stimulating hormone (FSH). Increased LH levels stimulate production of
sex steroids by testicular Leydig cells or ovarian granulosa cells. Pubertal
levels of androgens or estrogens cause the physical changes of puberty,
including d mechanisms that suppress onset of puberty include (1) the
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