Pediatric Medicine

Answer 5 Bone age determination. Premature thelarche, or the isolated onset of breast development, is most commonly seen before age 4 years in girls. Although this finding can represent the beginning of precocious puberty, puberty in most affected girls does not progress, and the remainder of pubertal development occurs at a normal age. Although the majority of cases are idiopathic, an assessment of whether the child has ingested any estrogen-containing medication can occasionally reveal a potential cause. A bone age determination will help rule out accelerated growth that may be associated with more serious conditions. Pelvic examination and breast biopsy are contraindicated-pelvic examination because of the potential trauma involved (pelvic ultrasound may be considered if indicated) and biopsy because of the potential damage to the breast bud which could prevent future breast development. Luteinizing hormone level is generally normal in these patients, although an elevated follicle-stimulating hormone level is occasionally seen. Karyotype analysis is not generally useful in determining the diagnosis. Click here to return to the questions

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