Case Report

Endocrinology Division

CENTRAL PRECOCIOUS PUBERTY

in A 2-year and 2-month old girl
Ikhsan Ali
Supervisor :
Prof. Dr. dr. R Satriono, M.Sc, Sp.A(K), Sp.GK
dr. Ratna Dewi Artati, Sp.A
dr. Kwari Januar Satriono, M.Kes, Sp.A

introduction

Precocious puberty is defined as pubertal

development which occurs too early, in girls
before 8 years, and boys before 9 years

2 classification of precocious puberty : (1) centra

precocious puberty (GnRH-dependent precocious
puberty) ; (2) peripheral precocious puberty (GnRHindependent precocious puberty)
Central precocious puberty happened in 90% in girls
and 50% in boys.

How to Diagnosis

History taking : growth and development since

birth, age of onset, family history, exogenous,
abnormality CNS, history of puberty
Physical examination : BW, BH, tanner stage of
puberty
Laboratory : LH, FSH, estardiol, testoteron
Radiologic : bone age, pelvic ultrasonography,
MRI

E
S
CA
T
R
O
P
RE

HISTORY
TAKING
Female, AI, 2 years 2 month, referred from Pelamonia hospital,
makassar with vaginal bleeding and breast development
vaginal bleeding since age 1 years and 6 months, periodically 3
to 4 days every month
breast development since age 7 months
Occured pubic and axilla hair since age 2 years.
no fever, convulsion, headache and also visual disturbance
History of menarche with her mother at age 14 years.

PHYSICAL
EXAMINATION

BB/TB : 18/13 x 100% =

138% Obesitas
TB/U : 94/88 x 100% =
106% Normal

laborator
y
CBC
Hb : 12,0 g/dl
Hct : 34,8%
WBC : 9500/mm3
PLT :
116000/mm3
Neut : 40,5%
Limf : 51%
Mono : 6,0%
Eos : 1,7%
Baso : 0,8%

GDS
: 66 mg/dl
LH
: 4,32 mIU/ml (normal 0,9-1,9)
FSH
: 6,01 mIU/ml (normal 0,67-3,3)
Estradiol
: 67 pg/ml (normal <= 53
URINALYSIS
Colour
: yellow
pH
: 6,0
BJ
: >=1.030
Protein
: negative
Glucose: negative
Blood
: negative
Leucocyte : +/70
Sed.Leu
:2
Sed.ery
:1

USG
Result
Based on morphologic and
haemodynamic from the
uterus, its suggestive on
precocius puberty

BONE AGE
RESULT
According grenlich and pyle,
the estimation of this bone age
are 5 years and 9 months

CT SCAN
RESULT
hypothalamic tumor
supect
hypothalamic
hamartoma

WORKING DIAGNOSIS

TREATMEN
T

DAY

VITAL SIGNS

PHYSICAL EXAMINATION

R/

1ST (FEBRUARY 11, 2015) 2ND (FEBRUARY 12, 2015

BP : 100/60 mmHg
P : 100 bpm
RR ; 24 bpm
BT : 37c

BP : 110/70 mmHg
P : 112 bpm
RR ; 22 bpm
BT : 37c

Breast development, pubic

and axilla hair growth,
tanner stage A2M3P2
Cafe au lait in the left of
forehead with size 7 x 3,5
cm

Breast development, pubic

and axilla hair growth,
tanner stage A2M3P2
Cafe au lait in the left of
forehead with size 7 x 3,5
cm

Agonist GnRH (leuprorelin)

3,75 mg/IM, single dose
Consult to neurosurgery

Consult to neurosurgery
no surgery intervention.
Check prolactin

DIAGNOSIS
DEFINITIVE

TREATMEN
T

PROGNOSIS

DISCUSSIO
N
Precocius puberty in girls is defined by breast
development occured before 8 years old
Clinical manifestation depends on the duration of
symptom, progressive of physical development, linier
acceleration, and bone-age advancement.
Diagnosis not just only by clinical manifestation but
there are also laboratory (hormonal tests) and
radiologic finding.

ETIOLOGY

Hypothalamic hamartoma congenital.

Recent studies hypothalamic hamartoma responsible for
sexual precocity in 10-28% of children
Partsch CJ and Sippel WG first choice treatment for
central precocious puberty in pediatric and neurosurgery
are long acting GnRH.

Monitorin
g

Regular evaluation adequacy and efficacy of the

treatment
Height, weight, growth velocity and stanner stage
Bone age, basal sex steroid, LH, FSH, and GnRH first
3 months and then every 6 months
Estradiol level becomes prepubertal, peak LH below
2,3 IU/L after a classical GnRH test or below 6,6 IU/L 2
hours after administration of DL adequacy of
treatment

SUMMARY
A case of central precocious puberty, two years
and two months old girl was reported. The
diagnosis were based on clinical and physical
examination, and also supportive examination.
She was treated on Gonadotropine Releasing
Hormone agonist called leuprorelin.