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An intriguing case of precocious puberty due to an ovarian mass in an infant

Devi Dayal1, Keerthivasan Seetharaman1, Prema Menon2

  • 1Endocrinology and Diabetes Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Pediatric Endocrinology, Diabetes, and Metabolism
|July 26, 2019
PubMed

Insights

A rare case of precocious puberty in a 15-month-old girl was likely caused by an ovarian cyst. Surgical removal of the cyst led to the regression of early pubertal development.

Area of Science:

  • Pediatric Endocrinology
  • Reproductive Endocrinology

Background:

  • Precocious puberty (PP) is defined as the onset of secondary sexual characteristics before age 8 in girls and age 9 in boys.
  • It can be classified as central (CPP) or peripheral (PPP), based on the source of gonadotropin stimulation.

Observation:

  • A 15-month-old girl presented with rapid pubertal development including breast and pubic hair growth, a growth spurt, and vaginal bleeding.
  • Initial presentation suggested central precocious puberty (CPP), but rapid progression and early menarche pointed towards peripheral precocious puberty (PPP).
  • Hormonal assays showed low LH concentrations, indicative of PPP, yet the LH:FSH ratio was suggestive of CPP.

Findings:

  • Abdominal imaging identified an ovarian mass, which was surgically removed.
  • Histopathological examination of the mass revealed hemorrhage and ovarian torsion, with its exact nature undetermined.
  • Post-operative regression of pubertal development was observed over three months.

Implications:

  • This case highlights the diagnostic challenges in differentiating CPP and PPP, especially with unusual presentations.
  • Autonomous ovarian cysts can be a rare cause of peripheral precocious puberty in young children.
  • Surgical intervention for ovarian masses in cases of suspected PP can lead to resolution of symptoms.

Keywords:
autonomous ovarian cystcentral precocious pubertypseudopubertyprecocious puberty

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